NPI Code Detail JSON Logo

1609680776 NPI number — ACTIVA MEDICAL CENTER & SPA

NPI Number: 1609680776
Health Care Provider/Practitioner: ACTIVA MEDICAL CENTER & SPA

Information about “1609680776” NPI (ACTIVA MEDICAL CENTER & SPA) exists in 1609680776 in HTML format HTML  |  1609680776 in plain Text format TXT  |  1609680776 in PDF (Portable Document Format) PDF  |  1609680776 in an XML format XML  formats.

NPI Number : 1609680776 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609680776",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ACTIVA MEDICAL CENTER & SPA",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "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": "11090 SW 64TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMI",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33173-2028",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "786-317-9247",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12966 SW 150TH TER",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MIAMI",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33186-7601",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "786-406-2497",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/06/2025",
    "LastUpdateDate": "02/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GONZALEZ",
    "AuthorizedOfficialFirstName": "AIMEE",
    "AuthorizedOfficialMiddleName": "TERESA",
    "AuthorizedOfficialTitle": "FAMILY NURSE PRACTITIONER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "APRN",
    "AuthorizedOfficialTelephoneNumber": "786-317-9247",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP2300X",
        "TaxonomyName": "Primary Care Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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