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1649441858 NPI number — LJR NEURO INTERVENTIONAL MEDICAL GROUP INC

NPI Number: 1649441858
Health Care Provider/Practitioner: LJR NEURO INTERVENTIONAL MEDICAL GROUP INC

Information about “1649441858” NPI (LJR NEURO INTERVENTIONAL MEDICAL GROUP INC) exists in 1649441858 in HTML format HTML  |  1649441858 in plain Text format TXT  |  1649441858 in PDF (Portable Document Format) PDF  |  1649441858 in an XML format XML  formats.

NPI Number : 1649441858 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649441858",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LJR NEURO INTERVENTIONAL MEDICAL GROUP INC",
    "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": "10150 SORRENTO VALLEY RD",
    "SecondLineMailingAddress": "SUITE 320",
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92121-1635",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "858-454-4235",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9888 GENESEE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LA JOLLA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92037-1205",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "858-626-6884",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/14/2008",
    "LastUpdateDate": "06/25/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MCCREIGHT",
    "AuthorizedOfficialFirstName": "PETER",
    "AuthorizedOfficialMiddleName": "H.B.",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "858-454-4235",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2085N0700X",
          "TaxonomyName": "Neuroradiology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        }
      ]
    }
  }
}
                
            

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