{
"Npi": {
"NPI": "1285809137",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FERNANDEZ-GONZALEZ",
"FirstName": "RODOLFO",
"MiddleName": "ANTONIO",
"NamePrefix": "DR.",
"NameSuffix": "SR.",
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FERNANDEZ-GONZALEZ",
"OtherFirstName": "RODOLFO",
"OtherMiddleName": "ANTONIO",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": "SR.",
"OtherCredential": "PH.D.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1708 AVE PONCE DE LEON",
"SecondLineMailingAddress": "SUIT 202",
"MailingAddressCityName": "SANTURCE",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00909-1918",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-728-6471",
"MailingAddressFaxNumber": "787-727-7155",
"FirstLinePracticeLocationAddress": "1708 AVE PONCE DE LEON",
"SecondLinePracticeLocationAddress": "SUIT 202",
"PracticeLocationAddressCityName": "SANTURCE",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00909-1918",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-728-6471",
"PracticeLocationAddressFaxNumber": "787-727-7155",
"EnumerationDate": "04/22/2008",
"LastUpdateDate": "04/13/2012",
"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": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "1303",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}