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1780947861 NPI number — BLAIR NICOLE MOSTOFI R.N.

NPI Number: 1780947861
Health Care Provider/Practitioner: BLAIR NICOLE MOSTOFI R.N.

Information about “1780947861” NPI (BLAIR NICOLE MOSTOFI R.N.) exists in 1780947861 in HTML format HTML  |  1780947861 in plain Text format TXT  |  1780947861 in PDF (Portable Document Format) PDF  |  1780947861 in an XML format XML  formats.

NPI Number : 1780947861 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780947861",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOSTOFI",
    "FirstName": "BLAIR",
    "MiddleName": "NICOLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "R.N.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MEASE",
    "OtherFirstName": "BLAIR",
    "OtherMiddleName": "NICOLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "108 S EL MOLINO AVE",
    "SecondLineMailingAddress": "UNIT 301",
    "MailingAddressCityName": "PASADENA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91101-2583",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-519-3234",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "13651 WILLARD ST.",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PANORAMA CITY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91402",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "818-375-2000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/22/2012",
    "LastUpdateDate": "12/06/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "4290",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "0019716386",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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