{
"Npi": {
"NPI": "1003613407",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PSICOBIENESTAR LLC",
"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": "PO BOX 64",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00690-0064",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "BO. CAIMITAL ALTO CARR #2 KM 121.8 INT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "AGUADILLA",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00603",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "939-433-9076",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/25/2025",
"LastUpdateDate": "03/05/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUTIERREZ",
"AuthorizedOfficialFirstName": "KAREN",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSYD",
"AuthorizedOfficialTelephoneNumber": "939-433-9076",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}