{
"Npi": {
"NPI": "1750237103",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "QUANTUM AI BLUE ZONE WELLNESS AND HOLISTIC REGENERATIVE SYSTEMS, NURSING AND NEUROECONOMIC LONGEVITY",
"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": "491 W 39TH ST APT 3",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN PEDRO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90731-7040",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "424-505-0486",
"MailingAddressFaxNumber": "424-999-0390",
"FirstLinePracticeLocationAddress": "491 W 39TH ST APT 3",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN PEDRO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90731-7040",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "424-505-0486",
"PracticeLocationAddressFaxNumber": "424-999-0390",
"EnumerationDate": "03/09/2026",
"LastUpdateDate": "03/09/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GENATO",
"AuthorizedOfficialFirstName": "GRETCHEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PMHNP-BC",
"AuthorizedOfficialTelephoneNumber": "424-505-0486",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}