{
"Npi": {
"NPI": "1508399445",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRESTIGE CARE AND MEDICAL SUPPLIES",
"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": "2901 S EL CAMINO REAL APT 313",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN MATEO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94403-2782",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "650-576-0483",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2901 S EL CAMINO REAL APT 313",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN MATEO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94403-2782",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "650-576-0483",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/07/2017",
"LastUpdateDate": "04/07/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PALOMARES",
"AuthorizedOfficialFirstName": "GREGORIO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "650-576-0483",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "B63179",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}