{
"Npi": {
"NPI": "1639957293",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HAIG",
"FirstName": "MARISA",
"MiddleName": "N",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MPH, RD, LDN, CPH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "RIVERA",
"OtherFirstName": "MARISA",
"OtherMiddleName": "NICOLE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MPH, RD, LDN, CPH",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3724 JEFFERSON ST STE 104",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AUSTIN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78731-6204",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "109 LA COSTA ST APT 503",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MELBOURNE BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32951-3479",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "321-431-3801",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/15/2023",
"LastUpdateDate": "02/06/2026",
"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": "133V00000X",
"TaxonomyName": "Registered Dietitian",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}