NPI Code Detail JSON Logo

1912362252 NPI number — HEADSPACE MEDICAL GROUP (CA), P.C.

NPI Number: 1912362252
Health Care Provider/Practitioner: HEADSPACE MEDICAL GROUP (CA), P.C.

Information about “1912362252” NPI (HEADSPACE MEDICAL GROUP (CA), P.C.) exists in 1912362252 in HTML format HTML  |  1912362252 in plain Text format TXT  |  1912362252 in PDF (Portable Document Format) PDF  |  1912362252 in an XML format XML  formats.

NPI Number : 1912362252 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912362252",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "HEADSPACE MEDICAL GROUP (CA), P.C.",
    "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": "2417 MICHIGAN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANTA MONICA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90404-4009",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "855-446-4374",
    "MailingAddressFaxNumber": "415-704-3356",
    "FirstLinePracticeLocationAddress": "595 MARKET ST STE 700",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN FRANCISCO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94105-2812",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "855-446-4374",
    "PracticeLocationAddressFaxNumber": "415-891-0725",
    "EnumerationDate": "12/30/2015",
    "LastUpdateDate": "09/04/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHTEMLER",
    "AuthorizedOfficialFirstName": "IRINA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "NETWORK OPERATIONS MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "855-446-4374",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0850X",
        "TaxonomyName": "Adult Mental Health Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.