NPI Code Detail JSON Logo

1902621469 NPI number — PRATHUSHA GRACE BETHALA

NPI Number: 1902621469
Health Care Provider/Practitioner: PRATHUSHA GRACE BETHALA

Information about “1902621469” NPI (PRATHUSHA GRACE BETHALA) exists in 1902621469 in HTML format HTML  |  1902621469 in plain Text format TXT  |  1902621469 in PDF (Portable Document Format) PDF  |  1902621469 in an XML format XML  formats.

NPI Number : 1902621469 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902621469",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BETHALA",
    "FirstName": "PRATHUSHA",
    "MiddleName": "GRACE",
    "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": "17915 CAMP COVE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CYPRESS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77429-7657",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-503-1518",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8000 RESEARCH FOREST DR STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "THE WOODLANDS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77382-1506",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "281-292-3861",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/20/2024",
    "LastUpdateDate": "11/20/2024",
    "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": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "74998",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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