1821173063 NPI number — JULIE CANO GOMEZ P.T. M.A.

NPI Number: 1821173063
Health Care Provider/Practitioner: JULIE CANO GOMEZ P.T. M.A.

NPI Number : 1821173063 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821173063",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOMEZ",
    "FirstName": "JULIE",
    "MiddleName": "CANO",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "P.T. M.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "145 N SIERRA MADRE BLVD",
    "SecondLineMailingAddress": "STE 8",
    "MailingAddressCityName": "PASADENA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91107-3371",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "626-396-6958",
    "MailingAddressFaxNumber": "626-396-6960",
    "FirstLinePracticeLocationAddress": "145 N SIERRA MADRE BLVD",
    "SecondLinePracticeLocationAddress": "STE 8",
    "PracticeLocationAddressCityName": "PASADENA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91107-3371",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-396-6958",
    "PracticeLocationAddressFaxNumber": "626-396-6960",
    "EnumerationDate": "10/26/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "10054",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}