{
"Npi": {
"NPI": "1043477995",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CENTRO CARDIOVASCULAR DE CAROLINA I",
"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 2250",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIO GRANDE",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00745-2239",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-757-0620",
"MailingAddressFaxNumber": "787-762-2730",
"FirstLinePracticeLocationAddress": "4A S3 ANEXO PISO 2 FRAGOSO AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CAROLINA",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00984",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-757-0825",
"PracticeLocationAddressFaxNumber": "787-762-2730",
"EnumerationDate": "05/19/2008",
"LastUpdateDate": "05/01/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FRED SANTANA",
"AuthorizedOfficialFirstName": "ROBERTO",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "787-757-0825",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}