{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "42382 BOB HOPE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RANCHO MIRAGE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92270-4469",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-341-9619",
"MailingAddressFaxNumber": "760-776-5861",
"FirstLinePracticeLocationAddress": "42382 BOB HOPE DR",
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"PracticeLocationAddressCityName": "RANCHO MIRAGE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92270-4469",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-341-9619",
"PracticeLocationAddressFaxNumber": "760-776-5861",
"EnumerationDate": "07/05/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANHART",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": "ANTHONY",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BC/HIS",
"AuthorizedOfficialTelephoneNumber": "760-341-9619",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "237600000X",
"TaxonomyName": "Audiologist-Hearing Aid Fitter",
"LicenseNumber": "HA3138",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}