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1831937895 NPI number — CRYSTAL MARIE MAKASARASHVILI

NPI Number: 1831937895
Health Care Provider/Practitioner: CRYSTAL MARIE MAKASARASHVILI

Information about “1831937895” NPI (CRYSTAL MARIE MAKASARASHVILI) exists in 1831937895 in HTML format HTML  |  1831937895 in plain Text format TXT  |  1831937895 in PDF (Portable Document Format) PDF  |  1831937895 in an XML format XML  formats.

NPI Number : 1831937895 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1831937895",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAKASARASHVILI",
    "FirstName": "CRYSTAL",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GARCIA",
    "OtherFirstName": "CRYSTAL",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "450 WAINWRIGHT AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN JOSE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95128-2163",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6840 VIA DEL ORO STE 210",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN JOSE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95119-1372",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "408-284-2280",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/16/2024",
    "LastUpdateDate": "01/13/2026",
    "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": "363LP0200X",
        "TaxonomyName": "Pediatric Nurse Practitioner",
        "LicenseNumber": "95030716",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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