{
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"FirstLineMailingAddress": "3790 7TH TER STE 102",
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"EnumerationDate": "06/18/2024",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VELASCO",
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"AuthorizedOfficialTelephoneNumber": "786-385-0175",
"Taxonomies": {
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}