NPI Code Detail JSON Logo

1669898193 NPI number — LIFESTYLE MEDICINE INSTITUTE LLC

NPI Number: 1669898193
Health Care Provider/Practitioner: LIFESTYLE MEDICINE INSTITUTE LLC

Information about “1669898193” NPI (LIFESTYLE MEDICINE INSTITUTE LLC) exists in 1669898193 in HTML format HTML  |  1669898193 in plain Text format TXT  |  1669898193 in PDF (Portable Document Format) PDF  |  1669898193 in an XML format XML  formats.

NPI Number : 1669898193 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669898193",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LIFESTYLE MEDICINE INSTITUTE LLC",
    "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": "25805 BARTON RD UNIT 106",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOMA LINDA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92354-3814",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-796-7676",
    "MailingAddressFaxNumber": "909-586-9342",
    "FirstLinePracticeLocationAddress": "25805 BARTON RD",
    "SecondLinePracticeLocationAddress": "BLDG. A, UNIT 106",
    "PracticeLocationAddressCityName": "LOMA LINDA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92354-3814",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-796-7676",
    "PracticeLocationAddressFaxNumber": "909-586-9342",
    "EnumerationDate": "03/07/2014",
    "LastUpdateDate": "06/04/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KUEHN",
    "AuthorizedOfficialFirstName": "JUSTINE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGING DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "408-209-2688",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "133V00000X",
        "TaxonomyName": "Registered Dietitian",
        "LicenseNumber": "01107466",
        "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."
      }
    }
  }
}
                
            

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