{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MIAMI GARDENS ORTHOPEDICS AND PAIN MANAGEMENT",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4888 NW 183RD ST STE 113",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIAMI GARDENS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33055-2940",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-317-3990",
"MailingAddressFaxNumber": "305-549-5314",
"FirstLinePracticeLocationAddress": "4888 NW 183RD ST STE 113",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIAMI GARDENS",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-317-3990",
"PracticeLocationAddressFaxNumber": "305-549-5314",
"EnumerationDate": "08/05/2022",
"LastUpdateDate": "08/05/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NICOLAS",
"AuthorizedOfficialFirstName": "MARICELA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "305-303-9154",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}