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1619332863 NPI number — CRYSTAL DOMYNIQUE MARTIN M.ED.

NPI Number: 1619332863
Health Care Provider/Practitioner: CRYSTAL DOMYNIQUE MARTIN M.ED.

Information about “1619332863” NPI (CRYSTAL DOMYNIQUE MARTIN M.ED.) exists in 1619332863 in HTML format HTML  |  1619332863 in plain Text format TXT  |  1619332863 in PDF (Portable Document Format) PDF  |  1619332863 in an XML format XML  formats.

NPI Number : 1619332863 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619332863",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARTIN",
    "FirstName": "CRYSTAL",
    "MiddleName": "DOMYNIQUE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.ED.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PINEIRO",
    "OtherFirstName": "CRYSTAL",
    "OtherMiddleName": "DOMYNIQUE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "513 CANARY AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MCALLEN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78504-2747",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "956-655-8987",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2009 N CONWAY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MISSION",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78572-2965",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "956-655-8987",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/15/2015",
    "LastUpdateDate": "06/05/2016",
    "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": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "72973",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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