{
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"FirstLineMailingAddress": "7374 SW 93RD AVE",
"SecondLineMailingAddress": "SUITE 203",
"MailingAddressCityName": "MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33173-5201",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-661-2002",
"MailingAddressFaxNumber": "305-661-2003",
"FirstLinePracticeLocationAddress": "7374 SW 93RD AVE",
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"PracticeLocationAddressTelephoneNumber": "305-661-2002",
"PracticeLocationAddressFaxNumber": "305-661-2003",
"EnumerationDate": "02/20/2009",
"LastUpdateDate": "04/19/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARDISA",
"AuthorizedOfficialFirstName": "ROSELIND",
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"AuthorizedOfficialTitle": "PRESIDENT/DOCTOR",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "305-661-2002",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Adult Medicine Physician",
"LicenseNumber": "OS 8030",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}