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1417373101 NPI number — OPTIMAL METABOLIC SOLUTIONS LLC

NPI Number: 1417373101
Health Care Provider/Practitioner: OPTIMAL METABOLIC SOLUTIONS LLC

Information about “1417373101” NPI (OPTIMAL METABOLIC SOLUTIONS LLC) exists in 1417373101 in HTML format HTML  |  1417373101 in plain Text format TXT  |  1417373101 in PDF (Portable Document Format) PDF  |  1417373101 in an XML format XML  formats.

NPI Number : 1417373101 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417373101",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "OPTIMAL METABOLIC SOLUTIONS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "40165 MURRIETA HOT SPRINGS RD",
    "SecondLineMailingAddress": "UNIT I",
    "MailingAddressCityName": "MURRIETA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92563-6434",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-461-1800",
    "MailingAddressFaxNumber": "951-667-3383",
    "FirstLinePracticeLocationAddress": "40165 MURRIETA HOT SPRINGS RD",
    "SecondLinePracticeLocationAddress": "UNIT I",
    "PracticeLocationAddressCityName": "MURRIETA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92563-6434",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-461-1800",
    "PracticeLocationAddressFaxNumber": "951-461-1800",
    "EnumerationDate": "03/05/2014",
    "LastUpdateDate": "10/19/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BANKER",
    "AuthorizedOfficialFirstName": "HEATHER",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "951-514-9277",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "324500000X",
        "TaxonomyName": "Substance Abuse Rehabilitation Facility",
        "LicenseNumber": "330123AP",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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