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1508375569 NPI number — ALEXANDRE APOSTOLOS THEODORAKIS CMT

NPI Number: 1508375569
Health Care Provider/Practitioner: ALEXANDRE APOSTOLOS THEODORAKIS CMT

Information about “1508375569” NPI (ALEXANDRE APOSTOLOS THEODORAKIS CMT) exists in 1508375569 in HTML format HTML  |  1508375569 in plain Text format TXT  |  1508375569 in PDF (Portable Document Format) PDF  |  1508375569 in an XML format XML  formats.

NPI Number : 1508375569 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1508375569",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "THEODORAKIS",
    "FirstName": "ALEXANDRE",
    "MiddleName": "APOSTOLOS",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "CMT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3905 CAMINITO TERVISO",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92122-1980",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "858-531-0289",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2615 CAMINO DEL RIO S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN DIEGO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92108-3713",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "619-542-0884",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/21/2017",
    "LastUpdateDate": "09/21/2017",
    "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": "225700000X",
        "TaxonomyName": "Massage Therapist",
        "LicenseNumber": "73118",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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