{
"Npi": {
"NPI": "1861512378",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SKINRX 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": "2222 SANTA MONICA BLVD",
"SecondLineMailingAddress": "STE 103",
"MailingAddressCityName": "SANTA MONICA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90404-2305",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-453-5557",
"MailingAddressFaxNumber": "310-828-5536",
"FirstLinePracticeLocationAddress": "2222 SANTA MONICA BLVD",
"SecondLinePracticeLocationAddress": "STE 103",
"PracticeLocationAddressCityName": "SANTA MONICA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90404-2305",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-453-5557",
"PracticeLocationAddressFaxNumber": "310-828-5536",
"EnumerationDate": "03/29/2007",
"LastUpdateDate": "09/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FOROOZAN",
"AuthorizedOfficialFirstName": "JESSICA",
"AuthorizedOfficialMiddleName": "AVIVA",
"AuthorizedOfficialTitle": "PRESIDENT/CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "310-453-5557",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY39520",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}