{
"Npi": {
"NPI": "1710074257",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIZA D CHAVEZ, MD., INC",
"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": "PO BOX 14642",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LONG BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90853-4642",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-633-2204",
"MailingAddressFaxNumber": "562-633-2579",
"FirstLinePracticeLocationAddress": "3650 E. SOUTH ST",
"SecondLinePracticeLocationAddress": "SUITE 308",
"PracticeLocationAddressCityName": "LAKEWOOD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90712-1405",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-633-2204",
"PracticeLocationAddressFaxNumber": "562-633-2579",
"EnumerationDate": "10/06/2006",
"LastUpdateDate": "09/29/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAVEZ",
"AuthorizedOfficialFirstName": "LIZA",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "562-633-2204",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RI0200X",
"TaxonomyName": "Infectious Disease Physician",
"LicenseNumber": "G76279",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}