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1679383384 NPI number — LUISA FERNANDA GONGORA DDS

NPI Number: 1679383384
Health Care Provider/Practitioner: LUISA FERNANDA GONGORA DDS

Information about “1679383384” NPI (LUISA FERNANDA GONGORA DDS) exists in 1679383384 in HTML format HTML  |  1679383384 in plain Text format TXT  |  1679383384 in PDF (Portable Document Format) PDF  |  1679383384 in an XML format XML  formats.

NPI Number : 1679383384 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679383384",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GONGORA",
    "FirstName": "LUISA",
    "MiddleName": "FERNANDA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6517 OLD OXFORD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89108-0201",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "617-461-2485",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "820 W BROADWAY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEEDLES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92363-2729",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "844-444-1424",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/14/2025",
    "LastUpdateDate": "01/14/2025",
    "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": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "111127",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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