{
"Npi": {
"NPI": "1760922413",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BETTINA LIMJOCO MDPC",
"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": "20072 SW BIRCH ST",
"SecondLineMailingAddress": "SUITE 170",
"MailingAddressCityName": "NEWPORT BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92660-0794",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-891-0945",
"MailingAddressFaxNumber": "949-201-9824",
"FirstLinePracticeLocationAddress": "20072 SW BIRCH ST",
"SecondLinePracticeLocationAddress": "SUITE 170",
"PracticeLocationAddressCityName": "NEWPORT BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92660-0794",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-891-0945",
"PracticeLocationAddressFaxNumber": "949-201-9824",
"EnumerationDate": "02/28/2017",
"LastUpdateDate": "02/28/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIMJOCO",
"AuthorizedOfficialFirstName": "BETTINA",
"AuthorizedOfficialMiddleName": "TAYENGCO",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "304-840-8406",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "C51899",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}