{
"Npi": {
"NPI": "1699505156",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BAHAELOU",
"FirstName": "MAHNAZ",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "AESTH, PMU",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BAHAELOU",
"OtherFirstName": "MAHNAZ",
"OtherMiddleName": null,
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "AESTH, PMU",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "11961 SANTA MONICA BOULEVARD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90025-2748",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-446-7878",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11961 SANTA MONICA BOULEVARD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90025-2748",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-446-7878",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/07/2024",
"LastUpdateDate": "08/07/2024",
"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": "221700000X",
"TaxonomyName": "Art Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}