{
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"OrgName": "PSICOLOGOS CLINICOS DEL SANTURCE MEDICAL MALL, CSP",
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"FirstLineMailingAddress": "1801 AVE PONCE DE LEON",
"SecondLineMailingAddress": "SUITE 311",
"MailingAddressCityName": "SAN JUAN",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00909-1900",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-727-2424",
"MailingAddressFaxNumber": "787-727-2424",
"FirstLinePracticeLocationAddress": "1801 AVE PONCE DE LEON",
"SecondLinePracticeLocationAddress": "SUITE 311",
"PracticeLocationAddressCityName": "SAN JUAN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-727-2424",
"PracticeLocationAddressFaxNumber": "787-727-2424",
"EnumerationDate": "06/21/2011",
"LastUpdateDate": "06/21/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAVEZ",
"AuthorizedOfficialFirstName": "MARIA",
"AuthorizedOfficialMiddleName": "ELIZABETH",
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"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "787-727-2424",
"Taxonomies": {
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"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "1165",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}