{
"Npi": {
"NPI": "1487839932",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "UNIVERSITY OF CALIFORNIA",
"ParentOrgTIN": null,
"OrgName": "UCSF FRESNO MEDICAL GROUP",
"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": "PO BOX 60000",
"SecondLineMailingAddress": "FILE 740522",
"MailingAddressCityName": "SAN FRANCISCO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94160-0001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "559-227-4810",
"MailingAddressFaxNumber": "559-227-4167",
"FirstLinePracticeLocationAddress": "3313 N HILLIARD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FRESNO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93726-5854",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "559-227-4810",
"PracticeLocationAddressFaxNumber": "559-227-4167",
"EnumerationDate": "01/03/2008",
"LastUpdateDate": "05/28/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VORIS",
"AuthorizedOfficialFirstName": "JOAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ASSOICATE DEAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MEDICAL DOCTOR",
"AuthorizedOfficialTelephoneNumber": "559-499-6427",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "103G00000X",
"TaxonomyName": "Clinical Neuropsychologist",
"LicenseNumber": "20822",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103G00000X",
"TaxonomyName": "Clinical Neuropsychologist",
"LicenseNumber": "PSY19509",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}