{
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"FirstLineMailingAddress": "HC 02 BOX 8653",
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"MailingAddressCityName": "YABUCOA",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00767",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "939-642-0775",
"MailingAddressFaxNumber": "180-050-7107",
"FirstLinePracticeLocationAddress": "CALLE PARANA 1669",
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"PracticeLocationAddressCityName": "SAN JUAN",
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"PracticeLocationAddressFaxNumber": "800-507-1075",
"EnumerationDate": "04/02/2014",
"LastUpdateDate": "01/30/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SEPULVEDA",
"AuthorizedOfficialFirstName": "LUIS",
"AuthorizedOfficialMiddleName": "ANGEL",
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"AuthorizedOfficialNameSuffix": "SR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "939-642-0775",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}