{
"Npi": {
"NPI": "1073434502",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CREALES MERCADO",
"FirstName": "HUASCAR",
"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": "3640 CALLE CUMBRE",
"SecondLineMailingAddress": "URB. EL MONTE",
"MailingAddressCityName": "PONCE",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00716-4809",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-379-0349",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "917 AVE TITO CASTRO FL 4",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PONCE",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00716-4717",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-848-2080",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/22/2026",
"LastUpdateDate": "07/22/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA-1066",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}