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1912626136 NPI number — MS. MODENA FRYE-PATCH

NPI Number: 1912626136
Health Care Provider/Practitioner: MS. MODENA FRYE-PATCH

Information about “1912626136” NPI (MS. MODENA FRYE-PATCH) exists in 1912626136 in HTML format HTML  |  1912626136 in plain Text format TXT  |  1912626136 in PDF (Portable Document Format) PDF  |  1912626136 in an XML format XML  formats.

NPI Number : 1912626136 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912626136",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FRYE-PATCH",
    "FirstName": "MODENA",
    "MiddleName": null,
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FRYE",
    "OtherFirstName": "MODENA",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1007 W LEXINGTON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POMONA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91766-5056",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-455-7685",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "303 W MANCHESTER BLVD STE 207",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INGLEWOOD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90301-1154",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "213-926-1100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/22/2022",
    "LastUpdateDate": "08/22/2022",
    "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": "106H00000X",
        "TaxonomyName": "Marriage & Family Therapist",
        "LicenseNumber": "AMFT99116",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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