{
"Npi": {
"NPI": "1215474432",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BORDALLO",
"FirstName": "SANDRA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MA, COUNSELING",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "P.O. BOX 27594",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BARRIGADA",
"MailingAddressStateName": "GUAM",
"MailingAddressPostalCode": "96921",
"MailingAddressCountryCode": "UM",
"MailingAddressTelephoneNumber": "671-888-9177",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "261A OLD PRICE ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MANGILAO",
"PracticeLocationAddressStateName": "GUAM",
"PracticeLocationAddressPostalCode": "96923",
"PracticeLocationAddressCountryCode": "UM",
"PracticeLocationAddressTelephoneNumber": "671-888-9177",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/25/2017",
"LastUpdateDate": "01/25/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YP2500X",
"TaxonomyName": "Professional Counselor",
"LicenseNumber": "LPC-109",
"LicenseNumberStateCode": "GU",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}