{
"Npi": {
"NPI": "1679043228",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "LAZARO PHYSICAL THERAPY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2612 ERSKINE LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAYWARD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94545-3028",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "415-724-5278",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "20861 WILBEAM AVE STE 9",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CASTRO VALLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94546-5832",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "415-724-5278",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/27/2018",
"LastUpdateDate": "06/27/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAZARO",
"AuthorizedOfficialFirstName": "EDMER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT, DPT, MS-HCA, OCS",
"AuthorizedOfficialTelephoneNumber": "415-724-5278",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}