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1841683984 NPI number — PAIN RECOVERY MEDICAL GROUP, INC

NPI Number: 1841683984
Health Care Provider/Practitioner: PAIN RECOVERY MEDICAL GROUP, INC

Information about “1841683984” NPI (PAIN RECOVERY MEDICAL GROUP, INC) exists in 1841683984 in HTML format HTML  |  1841683984 in plain Text format TXT  |  1841683984 in PDF (Portable Document Format) PDF  |  1841683984 in an XML format XML  formats.

NPI Number : 1841683984 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841683984",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PAIN RECOVERY MEDICAL GROUP, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 6747",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HUNTINGTON BEACH",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92615-6747",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "714-377-3749",
    "MailingAddressFaxNumber": "714-377-5642",
    "FirstLinePracticeLocationAddress": "34085 PACIFIC COAST HWY",
    "SecondLinePracticeLocationAddress": "#203",
    "PracticeLocationAddressCityName": "DANA POINT",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92629-2764",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-377-3749",
    "PracticeLocationAddressFaxNumber": "714-377-5642",
    "EnumerationDate": "03/13/2015",
    "LastUpdateDate": "03/13/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FULLER",
    "AuthorizedOfficialFirstName": "RENEE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "BUSINESS MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "562-308-0461",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QR0405X",
        "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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