{
"Npi": {
"NPI": "1629436134",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DMAT CA-6",
"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": "101 DALE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN CARLOS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94070-2940",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "202-731-3755",
"MailingAddressFaxNumber": "650-412-1815",
"FirstLinePracticeLocationAddress": "520 LOOP RD",
"SecondLinePracticeLocationAddress": "BLDG 4, A-137",
"PracticeLocationAddressCityName": "PALO ALTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94304-1207",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "202-731-3755",
"PracticeLocationAddressFaxNumber": "650-412-1815",
"EnumerationDate": "01/29/2016",
"LastUpdateDate": "08/27/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIPIN",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "UNIT COMMANDER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "292-731-3755",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251V00000X",
"TaxonomyName": "Voluntary or Charitable Agency",
"LicenseNumber": "G64161",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251K00000X",
"TaxonomyName": "Public Health or Welfare Agency",
"LicenseNumber": "G64161",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}