{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "PEDIATRIC PHYSICIANS GROUP INC",
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"FirstLineMailingAddress": "79-180 CORPORATE CIRCLE DR.",
"SecondLineMailingAddress": "SUITE 103",
"MailingAddressCityName": "LA QUINTA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92253-7235",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-777-7300",
"MailingAddressFaxNumber": "760-777-7707",
"FirstLinePracticeLocationAddress": "79-180 CORPORATE CIRCLE DR.",
"SecondLinePracticeLocationAddress": "SUITE 103",
"PracticeLocationAddressCityName": "LA QUINTA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-777-7300",
"PracticeLocationAddressFaxNumber": "760-777-7707",
"EnumerationDate": "06/25/2015",
"LastUpdateDate": "06/25/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FRASCHETTI",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "760-369-9220",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "20A8445",
"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."
}
}
}
}