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1568085751 NPI number — CAMILLE OLECHOWSKI MD PHD

NPI Number: 1568085751
Health Care Provider/Practitioner: CAMILLE OLECHOWSKI MD PHD

Information about “1568085751” NPI (CAMILLE OLECHOWSKI MD PHD) exists in 1568085751 in HTML format HTML  |  1568085751 in plain Text format TXT  |  1568085751 in PDF (Portable Document Format) PDF  |  1568085751 in an XML format XML  formats.

NPI Number : 1568085751 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568085751",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OLECHOWSKI",
    "FirstName": "CAMILLE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1805 N CALIFORNIA ST STE 201",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STOCKTON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95204-6032",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "209-645-4005",
    "MailingAddressFaxNumber": "209-645-6344",
    "FirstLinePracticeLocationAddress": "1805 N CALIFORNIA ST STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STOCKTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95204-6032",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "209-645-3771",
    "PracticeLocationAddressFaxNumber": "209-645-6344",
    "EnumerationDate": "05/21/2020",
    "LastUpdateDate": "09/16/2024",
    "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": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": "A194038",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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