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1962172924 NPI number — ANDY GONZALEZ DOMINGUEZ

NPI Number: 1962172924
Health Care Provider/Practitioner: ANDY GONZALEZ DOMINGUEZ

Information about “1962172924” NPI (ANDY GONZALEZ DOMINGUEZ) exists in 1962172924 in HTML format HTML  |  1962172924 in plain Text format TXT  |  1962172924 in PDF (Portable Document Format) PDF  |  1962172924 in an XML format XML  formats.

NPI Number : 1962172924 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962172924",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GONZALEZ DOMINGUEZ",
    "FirstName": "ANDY",
    "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": "7267 W 30TH LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HIALEAH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33018-5242",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "305-613-8947",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8180 NW 36TH ST STE 421",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DORAL",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33166-6686",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-320-6605",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/20/2021",
    "LastUpdateDate": "09/22/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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