{
"Npi": {
"NPI": "1699245217",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TIJERINO",
"FirstName": "HENRY",
"MiddleName": "MAURICIO",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "RPH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10949 DUNCAN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LYNWOOD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90262",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-221-1573",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2305 THEATRE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PASO ROBLES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93446-9604",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-227-4304",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/27/2018",
"LastUpdateDate": "03/27/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "79797",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}