1548662463 NPI number — MICHELLE VARELA MOLINA M.S., CCC-SLP

NPI Number: 1548662463
Health Care Provider/Practitioner: MICHELLE VARELA MOLINA M.S., CCC-SLP

NPI Number : 1548662463 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548662463",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VARELA MOLINA",
    "FirstName": "MICHELLE",
    "MiddleName": null,
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "M.S., CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "500 AVE LOS FILTROS APT 22",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GUAYNABO",
    "MailingAddressStateName": "PR",
    "MailingAddressPostalCode": "00971-9226",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "939-339-7252",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "114 N 2ND AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COVINA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91723-2112",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-732-1112",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/23/2014",
    "LastUpdateDate": "03/30/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "4182",
          "LicenseNumberStateCode": "PR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "5935",
          "LicenseNumberStateCode": "OK",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "29844",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}