{
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"FirstLineMailingAddress": "1310 S GREENWAY DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORAL GABLES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33134-4767",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-586-1695",
"MailingAddressFaxNumber": "786-515-9817",
"FirstLinePracticeLocationAddress": "8571 SW 112TH ST",
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"PracticeLocationAddressCityName": "MIAMI",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "786-815-6382",
"PracticeLocationAddressFaxNumber": "786-515-9817",
"EnumerationDate": "04/30/2010",
"LastUpdateDate": "06/04/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTINI",
"AuthorizedOfficialFirstName": "ANGELA",
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"AuthorizedOfficialTitle": "PRESIDENT/ DIRECTOR",
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"AuthorizedOfficialCredential": "M.S.",
"AuthorizedOfficialTelephoneNumber": "786-815-6382",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "6079",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}