{
"Npi": {
"NPI": "1609929058",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INBALANCE, A WOMEN'S HEALTH & WELLNESS CENTER, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "31105 RANCHO VIEJO RD",
"SecondLineMailingAddress": "SUITE C5",
"MailingAddressCityName": "SAN JUAN CAPISTRANO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92675-1717",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-218-4141",
"MailingAddressFaxNumber": "949-218-4242",
"FirstLinePracticeLocationAddress": "31105 RANCHO VIEJO RD",
"SecondLinePracticeLocationAddress": "SUITE C5",
"PracticeLocationAddressCityName": "SAN JUAN CAPISTRANO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92675-1717",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-218-4141",
"PracticeLocationAddressFaxNumber": "949-218-4242",
"EnumerationDate": "01/19/2007",
"LastUpdateDate": "01/07/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SEDELL",
"AuthorizedOfficialFirstName": "HAYLEY",
"AuthorizedOfficialMiddleName": "SUE",
"AuthorizedOfficialTitle": "VICE-PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MPT",
"AuthorizedOfficialTelephoneNumber": "949-218-4141",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "PT21120",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}