{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"Credential": null,
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"FirstLineMailingAddress": "CALLE 30 UU 48 STA JUANITA",
"SecondLineMailingAddress": null,
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-786-0755",
"MailingAddressFaxNumber": "787-787-6557",
"FirstLinePracticeLocationAddress": "CALLE 30 UU 48 STA JUANITA",
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"PracticeLocationAddressCityName": "BAYAMON",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "787-787-6557",
"EnumerationDate": "02/16/2007",
"LastUpdateDate": "12/22/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COUSO",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "787-786-0755",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}