{
"Npi": {
"NPI": "1154542967",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARCANO-CENTENO",
"FirstName": "GEOVANNIE",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MARCANO",
"OtherFirstName": "GEOVANNIE",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1179 NW 166TH AVE",
"SecondLineMailingAddress": "PEMBROKE PINES",
"MailingAddressCityName": "PEMBROKE PINES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33028-1344",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "754-400-8644",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1179 NW 166TH AVE",
"SecondLinePracticeLocationAddress": "PEMBROKE PINES",
"PracticeLocationAddressCityName": "PEMBROKE PINES",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33028-1344",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "754-400-8644",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/01/2007",
"LastUpdateDate": "07/03/2014",
"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": "282N00000X",
"TaxonomyName": "General Acute Care Hospital",
"LicenseNumber": "13887",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207P00000X",
"TaxonomyName": "Emergency Medicine Physician",
"LicenseNumber": "ME102854",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}