NPI Code Detail JSON Logo

1609492768 NPI number — CHRISTY MARIE MEDNICK

NPI Number: 1609492768
Health Care Provider/Practitioner: CHRISTY MARIE MEDNICK

Information about “1609492768” NPI (CHRISTY MARIE MEDNICK) exists in 1609492768 in HTML format HTML  |  1609492768 in plain Text format TXT  |  1609492768 in PDF (Portable Document Format) PDF  |  1609492768 in an XML format XML  formats.

NPI Number : 1609492768 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609492768",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MEDNICK",
    "FirstName": "CHRISTY",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "927 CRAIG PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAVIS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95616-2513",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "949-267-8865",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8801 FOLSOM BLVD STE 195",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SACRAMENTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95826-3231",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "916-382-4447",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/24/2020",
    "LastUpdateDate": "06/24/2020",
    "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": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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