{
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"OrgName": "MAXIMA THERAPY AND SPEECH CLINIC, INC.",
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"FirstLineMailingAddress": "3940 LAUREL CANYON BLVD",
"SecondLineMailingAddress": "SUITE 456",
"MailingAddressCityName": "STUDIO CITY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91604-3709",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-287-8875",
"MailingAddressFaxNumber": "818-704-7898",
"FirstLinePracticeLocationAddress": "5217 ETIWANDA AVE",
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"PracticeLocationAddressCityName": "TARZANA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "509-430-1111",
"PracticeLocationAddressFaxNumber": "818-704-7898",
"EnumerationDate": "08/02/2010",
"LastUpdateDate": "03/15/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ZUBATOV",
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"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": "B.S.",
"AuthorizedOfficialTelephoneNumber": "509-430-1111",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0700X",
"TaxonomyName": "Hearing and Speech Clinic/Center",
"LicenseNumber": "SP 13829",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}