{
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"IsOrgSubpart": "N",
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"OrgName": "ALELI VIDAD MD, INC",
"LastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 4477",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARSON CITY",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89702-4477",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "775-883-3336",
"MailingAddressFaxNumber": "775-883-0877",
"FirstLinePracticeLocationAddress": "501 N. NAVAJO DR",
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"PracticeLocationAddressCityName": "PAGE",
"PracticeLocationAddressStateName": "AZ",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "775-883-3336",
"PracticeLocationAddressFaxNumber": "775-883-0877",
"EnumerationDate": "03/06/2012",
"LastUpdateDate": "03/06/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VIDAD",
"AuthorizedOfficialFirstName": "ALELI",
"AuthorizedOfficialMiddleName": "FAVILA",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "775-881-8543",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "12435",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}