{
"Npi": {
"NPI": "1528198512",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CAREMAX OF SACRAMENTO, FBA, INC",
"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": "1716 MELANZANE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROSEVILLE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95661-3986",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-789-7391",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7641 GALILEE ROAD",
"SecondLinePracticeLocationAddress": "SUITE # 150",
"PracticeLocationAddressCityName": "ROSEVILLE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95678",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-788-9788",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/07/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANDRES",
"AuthorizedOfficialFirstName": "FERNANDO",
"AuthorizedOfficialMiddleName": "B.",
"AuthorizedOfficialTitle": "C.E.O.",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "916-622-2092",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "033454",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}