{
"Npi": {
"NPI": "1679710362",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PATTON STATE HOSPITAL",
"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": "3102 E HIGHLAND AVE",
"SecondLineMailingAddress": "PROGRAM 4, UNIT 35",
"MailingAddressCityName": "PATTON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92369-7813",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-425-7363",
"MailingAddressFaxNumber": "909-425-6208",
"FirstLinePracticeLocationAddress": "3102 E HIGHLAND AVE",
"SecondLinePracticeLocationAddress": "PROGRAM 4, UNIT 35",
"PracticeLocationAddressCityName": "PATTON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92369-7813",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-425-7363",
"PracticeLocationAddressFaxNumber": "909-425-6208",
"EnumerationDate": "01/16/2009",
"LastUpdateDate": "01/16/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAMANAHA",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "STAFF PSYCHOLOGIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "909-425-7363",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "283Q00000X",
"TaxonomyName": "Psychiatric Hospital",
"LicenseNumber": "21662",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}