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1679187702 NPI number — JENNIFER BIALOS

NPI Number: 1679187702
Health Care Provider/Practitioner: JENNIFER BIALOS

Information about “1679187702” NPI (JENNIFER BIALOS) exists in 1679187702 in HTML format HTML  |  1679187702 in plain Text format TXT  |  1679187702 in PDF (Portable Document Format) PDF  |  1679187702 in an XML format XML  formats.

NPI Number : 1679187702 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679187702",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BIALOS",
    "FirstName": "JENNIFER",
    "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": "1866 35TH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VERO BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32960-2521",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "772-925-4861",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "900 27TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VERO BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32960-4011",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "772-569-5699",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/05/2020",
    "LastUpdateDate": "03/14/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "09/14/2020",
    "NPIReactivationDate": "04/07/2021",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "374700000X",
        "TaxonomyName": "Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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