{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "CENTRAL COAST INSTITUTE FOR PLASTIC SURGERY, AMC",
"LastName": null,
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"NamePrefix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "1531 HIGUERA ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN LUIS OBISPO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93401-2917",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-544-6000",
"MailingAddressFaxNumber": "805-544-5460",
"FirstLinePracticeLocationAddress": "1531 HIGUERA ST",
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"PracticeLocationAddressCityName": "SAN LUIS OBISPO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-544-6000",
"PracticeLocationAddressFaxNumber": "805-544-5460",
"EnumerationDate": "02/12/2008",
"LastUpdateDate": "05/21/2008",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DONATH",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "805-544-6000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "A50869",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}