{
"Npi": {
"NPI": "1689057960",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DAVID PICELLA PHD INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "836 N DEL SOL LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DIAMOND BAR",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91765-1105",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-241-8200",
"MailingAddressFaxNumber": "909-245-1751",
"FirstLinePracticeLocationAddress": "1617 N GAREY AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POMONA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91767",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-241-8200",
"PracticeLocationAddressFaxNumber": "909-245-1751",
"EnumerationDate": "07/03/2015",
"LastUpdateDate": "08/03/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PICELLA",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "VINCENT",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD, NP",
"AuthorizedOfficialTelephoneNumber": "877-241-8200",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "364S00000X",
"TaxonomyName": "Clinical Nurse Specialist",
"LicenseNumber": "269",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "10299",
"LicenseNumberStateCode": "CA",
"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."
},
{
"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."
},
{
"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."
}
]
}
}
}