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1972092781 NPI number — LISA NICOLE MAZZOCCO NP

NPI Number: 1972092781
Health Care Provider/Practitioner: LISA NICOLE MAZZOCCO NP

Information about “1972092781” NPI (LISA NICOLE MAZZOCCO NP) exists in 1972092781 in HTML format HTML  |  1972092781 in plain Text format TXT  |  1972092781 in PDF (Portable Document Format) PDF  |  1972092781 in an XML format XML  formats.

NPI Number : 1972092781 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972092781",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAZZOCCO",
    "FirstName": "LISA",
    "MiddleName": "NICOLE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ORTEGA",
    "OtherFirstName": "LISA",
    "OtherMiddleName": "NICOLE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "13423 OCEAN GATE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HAWTHORNE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90250-5611",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-643-8117",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "25825 VERMONT AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HARBOR CITY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90710-3518",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-517-6441",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/07/2018",
    "LastUpdateDate": "05/07/2018",
    "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": "363LA2100X",
        "TaxonomyName": "Acute Care Nurse Practitioner",
        "LicenseNumber": "95008622",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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