NPI Code Detail JSON Logo

1841551587 NPI number — MRS. NEOMA JEAN MASTRUZZO

NPI Number: 1841551587
Health Care Provider/Practitioner: MRS. NEOMA JEAN MASTRUZZO

Information about “1841551587” NPI (MRS. NEOMA JEAN MASTRUZZO) exists in 1841551587 in HTML format HTML  |  1841551587 in plain Text format TXT  |  1841551587 in PDF (Portable Document Format) PDF  |  1841551587 in an XML format XML  formats.

NPI Number : 1841551587 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841551587",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MASTRUZZO",
    "FirstName": "NEOMA",
    "MiddleName": "JEAN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5516 RED SUN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89149-6673",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-204-1643",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3680 N RANCHO DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89130-3180",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-896-4300",
    "PracticeLocationAddressFaxNumber": "702-896-4301",
    "EnumerationDate": "05/29/2012",
    "LastUpdateDate": "05/29/2012",
    "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": "103K00000X",
        "TaxonomyName": "Behavior Analyst",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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