{
"Npi": {
"NPI": "1972650513",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HAYWARD L EUBANKS M D A MEDICAL CORPORATION",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5529 SECREST DRIVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90043-2029",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-679-0676",
"MailingAddressFaxNumber": "323-296-4776",
"FirstLinePracticeLocationAddress": "4477 W 118TH STREET",
"SecondLinePracticeLocationAddress": "SUITE 205",
"PracticeLocationAddressCityName": "HAWTHORNE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90250-2255",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-679-0676",
"PracticeLocationAddressFaxNumber": "310-679-0087",
"EnumerationDate": "01/05/2007",
"LastUpdateDate": "10/22/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EUBANKS",
"AuthorizedOfficialFirstName": "BRITTANY",
"AuthorizedOfficialMiddleName": "LYNITA",
"AuthorizedOfficialTitle": "PRACTICE MANAGER, ACCESS MANAGER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "310-908-1842",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207YX0905X",
"TaxonomyName": "Otolaryngology/Facial Plastic Surgery Physician",
"LicenseNumber": "G54388",
"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."
}
}
}
}