{
"Npi": {
"NPI": "1720667132",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ESPINOZA",
"FirstName": "SERGIO",
"MiddleName": null,
"NamePrefix": "MR.",
"NameSuffix": "SR.",
"Credential": "MASSAGE THERAPIST",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "ESPINOZA",
"OtherFirstName": "SERGIO",
"OtherMiddleName": null,
"OtherNamePrefix": "MR.",
"OtherNameSuffix": "SR.",
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1812 W SUNSET BLVD # 1-537",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ST GEORGE",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84770-6565",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "352 E RIVERSIDE DR # A-11",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ST GEORGE",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84790-6758",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-232-6326",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/04/2021",
"LastUpdateDate": "04/04/2021",
"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": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "12153378-4701",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}