{
"Npi": {
"NPI": "1407094212",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SANTA ROSA CLINIC, PA",
"ParentOrgTIN": null,
"OrgName": "SANTA ROSA CLINIC, PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "355 RICHARDSON RD SE STE 6",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CALHOUN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30701-3681",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-625-2237",
"MailingAddressFaxNumber": "706-625-2239",
"FirstLinePracticeLocationAddress": "355 RICHARDSON RD SE STE 6",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CALHOUN",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30701-3681",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "706-625-2237",
"PracticeLocationAddressFaxNumber": "706-625-2239",
"EnumerationDate": "02/02/2009",
"LastUpdateDate": "02/02/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MALPARTIDA",
"AuthorizedOfficialFirstName": "JUAN",
"AuthorizedOfficialMiddleName": "CARLOS",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "706-259-5579",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": "53528",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": "50406",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}