{
"Npi": {
"NPI": "1639373277",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MINJAREZ",
"FirstName": "RENEE",
"MiddleName": "CAROLE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1135 116TH AVE NE",
"SecondLineMailingAddress": "SUITE 305",
"MailingAddressCityName": "BELLEVUE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98004-4623",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-592-5000",
"MailingAddressFaxNumber": "206-824-9510",
"FirstLinePracticeLocationAddress": "1135 116TH AVE NE",
"SecondLinePracticeLocationAddress": "SUITE 305",
"PracticeLocationAddressCityName": "BELLEVUE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98004-4623",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-453-1772",
"PracticeLocationAddressFaxNumber": "425-453-0603",
"EnumerationDate": "06/14/2007",
"LastUpdateDate": "03/03/2015",
"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": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": "LL16254",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2086S0129X",
"TaxonomyName": "Vascular Surgery Physician",
"LicenseNumber": "MD60158478",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}