{
"Npi": {
"NPI": "1679129480",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MORENO",
"FirstName": "KRISTAL",
"MiddleName": "MARIE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BENITZ",
"OtherFirstName": "KRISTAL",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "300 MIKE LOZA DR UNIT 109",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAMARILLO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93012-8479",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-307-6296",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "244 E CLARA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORT HUENEME",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93041-2732",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-307-6296",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/16/2019",
"LastUpdateDate": "08/16/2019",
"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": "164X00000X",
"TaxonomyName": "Licensed Vocational Nurse",
"LicenseNumber": "689647",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}