{
"Npi": {
"NPI": "1629321203",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COLLINS",
"FirstName": "JESSICA",
"MiddleName": "SAYA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D., F.R.C.S.C.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "COLIN-DURAND",
"OtherFirstName": "JESSICA",
"OtherMiddleName": "NATALIE ALEXANDRA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5893 COPLEY DR",
"SecondLineMailingAddress": "4TH FLOOR PLASTIC SURGERY CLINIC",
"MailingAddressCityName": "SAN DIEGO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92111-7906",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "844-616-5001",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5893 COPLEY DR",
"SecondLinePracticeLocationAddress": "4TH FLOOR PLASTIC SURGERY CLINIC",
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92111",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "844-616-5001",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/19/2012",
"LastUpdateDate": "12/22/2021",
"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": "208200000X",
"TaxonomyName": "Plastic Surgery Physician",
"LicenseNumber": "A 123315",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}