{
"Npi": {
"NPI": "1568817617",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FORENSIC BLOOD SERVICES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5750 IAN CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SACRAMENTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95842-2254",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-540-1225",
"MailingAddressFaxNumber": "916-723-5856",
"FirstLinePracticeLocationAddress": "5750 IAN CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SACRAMENTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95842-2254",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-540-1225",
"PracticeLocationAddressFaxNumber": "916-723-5856",
"EnumerationDate": "04/26/2016",
"LastUpdateDate": "04/26/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MENJIVAR",
"AuthorizedOfficialFirstName": "MONICA",
"AuthorizedOfficialMiddleName": "LEE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPA",
"AuthorizedOfficialTelephoneNumber": "707-540-1225",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": "CPA3892",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}