{
"Npi": {
"NPI": "1639691397",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SARAH APOLLO DT PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 36",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DANA POINT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92629-0036",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-202-7909",
"MailingAddressFaxNumber": "866-242-5109",
"FirstLinePracticeLocationAddress": "22 ODYSSEY STE 155",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "IRVINE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92618-3194",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-202-7909",
"PracticeLocationAddressFaxNumber": "866-242-5109",
"EnumerationDate": "07/13/2017",
"LastUpdateDate": "07/28/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SANDERSON",
"AuthorizedOfficialFirstName": "DEBRA",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "CLINIC MANGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "661-993-8941",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": "20A6613",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207QA0401X",
"TaxonomyName": "Addiction Medicine (Family Medicine) Physician",
"LicenseNumber": "20A6613",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}