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1851071690 NPI number — IMMUNOCINE, LLC

NPI Number: 1851071690
Health Care Provider/Practitioner: IMMUNOCINE, LLC

Information about “1851071690” NPI (IMMUNOCINE, LLC) exists in 1851071690 in HTML format HTML  |  1851071690 in plain Text format TXT  |  1851071690 in PDF (Portable Document Format) PDF  |  1851071690 in an XML format XML  formats.

NPI Number : 1851071690 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851071690",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "IMMUNOCINE, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3422 BUSINESS CENTER DR",
    "SecondLineMailingAddress": "STE 106 #1123",
    "MailingAddressCityName": "PEARLAND",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77584-4159",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "888-575-2572",
    "MailingAddressFaxNumber": "832-827-4875",
    "FirstLinePracticeLocationAddress": "BOULEVARD LUIS DONALDO COLOSO (AV TULUM) MANZANA 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CANCUN",
    "PracticeLocationAddressStateName": "Q.R.",
    "PracticeLocationAddressPostalCode": "77504",
    "PracticeLocationAddressCountryCode": "MX",
    "PracticeLocationAddressTelephoneNumber": "888-575-2572",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/18/2023",
    "LastUpdateDate": "04/23/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HALPERT",
    "AuthorizedOfficialFirstName": "MATTHEW",
    "AuthorizedOfficialMiddleName": "MARTIN",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHD",
    "AuthorizedOfficialTelephoneNumber": "832-814-2185",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RH0002X",
          "TaxonomyName": "Hospice and Palliative Medicine (Internal Medicine) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RI0001X",
          "TaxonomyName": "Clinical & Laboratory Immunology (Internal Medicine) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RX0202X",
          "TaxonomyName": "Medical Oncology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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