{
"Npi": {
"NPI": "1972957363",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEUROVASCULAR INSTITUTE OF THOUSAND OAKS INC",
"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": "107 N REINO RD # 409",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEWBURY PARK",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91320-3710",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-795-7656",
"MailingAddressFaxNumber": "805-618-1501",
"FirstLinePracticeLocationAddress": "2100 LYNN RD",
"SecondLinePracticeLocationAddress": "SUITE 120",
"PracticeLocationAddressCityName": "THOUSAND OAKS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91360-8033",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-795-7656",
"PracticeLocationAddressFaxNumber": "805-618-1501",
"EnumerationDate": "04/21/2016",
"LastUpdateDate": "11/02/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAQI",
"AuthorizedOfficialFirstName": "MUHAMMAD",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "760-423-3942",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085N0700X",
"TaxonomyName": "Neuroradiology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}