{
"Npi": {
"NPI": "1427207075",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NILDA G. MEDINA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1773",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAROLINA",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00984-1773",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-762-4555",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "CASTELLANA GARDENS CAMPO RICO AVE.",
"SecondLinePracticeLocationAddress": "R5 NUMBER 7",
"PracticeLocationAddressCityName": "CAROLINA",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00983",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-762-4555",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/18/2008",
"LastUpdateDate": "09/18/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEDINA",
"AuthorizedOfficialFirstName": "NILDA",
"AuthorizedOfficialMiddleName": "G.",
"AuthorizedOfficialTitle": "OWNER PSYCHOLOGIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "787-762-4555",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "1963",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}