{
"Npi": {
"NPI": "1447803986",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COVARRUBIAS",
"FirstName": "VICTOR",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PMHNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "21550 OXNARD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODLAND HILLS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91367-7100",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-850-3250",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "21550 OXNARD ST FL 3",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WOODLAND HILLS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91367-7105",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-913-0090",
"PracticeLocationAddressFaxNumber": "747-888-5865",
"EnumerationDate": "07/23/2019",
"LastUpdateDate": "10/10/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "163WP0807X",
"TaxonomyName": "Child & Adolescent Psychiatric/Mental Health Registered Nurse",
"LicenseNumber": "95147346",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "95024768",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}