{
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"FirstLineMailingAddress": "PO BOX 141394",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ARECIBO",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-820-9268",
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"FirstLinePracticeLocationAddress": "CARR 119 KM 0.69 ESTANCIAS DE HATILLO",
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"PracticeLocationAddressFaxNumber": "787-820-9268",
"EnumerationDate": "02/21/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TOLEDO RIVERA",
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"AuthorizedOfficialCredential": "MT. LIC 2750 OWNER",
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}
},
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}
}