{
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"FirstLineMailingAddress": "PMB 289-200",
"SecondLineMailingAddress": "AVE. RAFAEL CORDERO",
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"EnumerationDate": "06/09/2014",
"LastUpdateDate": "05/21/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GONZALEZ",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}