{
"Npi": {
"NPI": "1912085069",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FOOT AND ANKLE INSTITUTE OF THE WEST",
"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": "18433 ROSCOE BLVD STE 214",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTHRIDGE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91325-4123",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-623-4455",
"MailingAddressFaxNumber": "818-691-7099",
"FirstLinePracticeLocationAddress": "25272 MCINTYRE ST STE H",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAGUNA HILLS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92653-5449",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "186-234-4558",
"PracticeLocationAddressFaxNumber": "818-691-7099",
"EnumerationDate": "11/02/2006",
"LastUpdateDate": "09/02/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FAURIA",
"AuthorizedOfficialFirstName": "QUINN",
"AuthorizedOfficialMiddleName": "MARTIN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "818-623-4455",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "BUS0301512",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}