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1770396103 NPI number — STEPHEN MCCAIN CNC, CPT, OLY

NPI Number: 1770396103
Health Care Provider/Practitioner: STEPHEN MCCAIN CNC, CPT, OLY

Information about “1770396103” NPI (STEPHEN MCCAIN CNC, CPT, OLY) exists in 1770396103 in HTML format HTML  |  1770396103 in plain Text format TXT  |  1770396103 in PDF (Portable Document Format) PDF  |  1770396103 in an XML format XML  formats.

NPI Number : 1770396103 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770396103",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCAIN",
    "FirstName": "STEPHEN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CNC, CPT, OLY",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8744 MESA CANOGO DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89148-1433",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-717-8686",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8744 MESA CANOGO DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89148-1433",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-717-8686",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/29/2025",
    "LastUpdateDate": "01/29/2025",
    "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": "224Y00000X",
          "TaxonomyName": "Clinical Exercise Physiologist",
          "LicenseNumber": "1200502608",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171400000X",
          "TaxonomyName": "Health & Wellness Coach",
          "LicenseNumber": "1190351195",
          "LicenseNumberStateCode": "CA",
          "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."
      }
    }
  }
}
                
            

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