NPI Code Detail JSON Logo

1528162104 NPI number — AERON BIOTECHNOLOGY INC

NPI Number: 1528162104
Health Care Provider/Practitioner: AERON BIOTECHNOLOGY INC

Information about “1528162104” NPI (AERON BIOTECHNOLOGY INC) exists in 1528162104 in HTML format HTML  |  1528162104 in plain Text format TXT  |  1528162104 in PDF (Portable Document Format) PDF  |  1528162104 in an XML format XML  formats.

NPI Number : 1528162104 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528162104",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "AERON BIOTECHNOLOGY INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1933 DAVIS STREET",
    "SecondLineMailingAddress": "SUITE 310",
    "MailingAddressCityName": "SAN LEANDRO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94577",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "510-729-0375",
    "MailingAddressFaxNumber": "510-729-0383",
    "FirstLinePracticeLocationAddress": "1933 DAVIS STREET",
    "SecondLinePracticeLocationAddress": "SUITE 310",
    "PracticeLocationAddressCityName": "SAN LEANDRO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94577",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "510-729-0375",
    "PracticeLocationAddressFaxNumber": "510-729-0383",
    "EnumerationDate": "09/12/2006",
    "LastUpdateDate": "11/27/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DOLLBAUM",
    "AuthorizedOfficialFirstName": "CHARLES",
    "AuthorizedOfficialMiddleName": "M",
    "AuthorizedOfficialTitle": "VICE PRESIDENT MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD PHD",
    "AuthorizedOfficialTelephoneNumber": "510-729-0375",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "291U00000X",
          "TaxonomyName": "Clinical Medical Laboratory",
          "LicenseNumber": "PFI7360805171AZ",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "291U00000X",
          "TaxonomyName": "Clinical Medical Laboratory",
          "LicenseNumber": "800001949",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "291U00000X",
          "TaxonomyName": "Clinical Medical Laboratory",
          "LicenseNumber": "CLIA05D0600602",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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