{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MARIO A. PACADA, DPM, INC",
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"FirstLineMailingAddress": "3756 SANTA ROSALIA DR STE 302",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90008-3615",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-208-0713",
"MailingAddressFaxNumber": "562-684-0289",
"FirstLinePracticeLocationAddress": "3756 SANTA ROSALIA DR STE 302",
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"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressTelephoneNumber": "562-208-0713",
"PracticeLocationAddressFaxNumber": "562-684-0289",
"EnumerationDate": "07/10/2008",
"LastUpdateDate": "07/10/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PACADA",
"AuthorizedOfficialFirstName": "MARIO",
"AuthorizedOfficialMiddleName": "ANTONYO",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "562-209-0713",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "E4163",
"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."
}
}
}
}