{
"Npi": {
"NPI": "1588184055",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JORDAN",
"FirstName": "MARIANELA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GOMEZ RINCON",
"OtherFirstName": "MARIANELA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4650 W SUNSET BLVD",
"SecondLineMailingAddress": "MAIL STOP #2",
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90027-6062",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "323-361-2153",
"MailingAddressFaxNumber": "323-953-8116",
"FirstLinePracticeLocationAddress": "3250 WILSHIRE BLVD STE 300",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90010-1439",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "323-361-2153",
"PracticeLocationAddressFaxNumber": "323-953-8116",
"EnumerationDate": "06/26/2017",
"LastUpdateDate": "04/08/2024",
"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": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "A169505",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2080A0000X",
"TaxonomyName": "Pediatric Adolescent Medicine Physician",
"LicenseNumber": "A169505",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}