{
"Npi": {
"NPI": "1144538364",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HUMBERTO A DOMINGUEZ MD PA",
"LastName": null,
"FirstName": null,
"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": "70 FOX RIDGE CT",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "DEBARY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32713-2752",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "386-668-4411",
"MailingAddressFaxNumber": "386-668-8688",
"FirstLinePracticeLocationAddress": "70 FOX RIDGE CT",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "DEBARY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32713-2752",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "386-668-4411",
"PracticeLocationAddressFaxNumber": "386-668-8688",
"EnumerationDate": "09/22/2010",
"LastUpdateDate": "06/20/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DOMINGUEZ",
"AuthorizedOfficialFirstName": "HUMBERTO",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "386-668-4411",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "ME29577",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}