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1629301874 NPI number — KAREN ANN RANDOLPH CMT, ED D

NPI Number: 1629301874
Health Care Provider/Practitioner: KAREN ANN RANDOLPH CMT, ED D

Information about “1629301874” NPI (KAREN ANN RANDOLPH CMT, ED D) exists in 1629301874 in HTML format HTML  |  1629301874 in plain Text format TXT  |  1629301874 in PDF (Portable Document Format) PDF  |  1629301874 in an XML format XML  formats.

NPI Number : 1629301874 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629301874",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RANDOLPH",
    "FirstName": "KAREN",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CMT, ED D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3950 MILTON DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EL SOBRANTE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94803-3024",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "510-275-3895",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5 BON AIR RD STE C-116",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LARKSPUR",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94939-1143",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "510-417-5773",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/04/2009",
    "LastUpdateDate": "09/04/2009",
    "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": "173C00000X",
        "TaxonomyName": "Reflexologist",
        "LicenseNumber": "703556",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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