{
"Npi": {
"NPI": "1518091107",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TERESA LONGORIA MD LLC",
"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": "2102 N COUNTRY CLUB RD",
"SecondLineMailingAddress": "SUITE 4",
"MailingAddressCityName": "TUCSON",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85716-2831",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "520-325-6633",
"MailingAddressFaxNumber": "520-325-6644",
"FirstLinePracticeLocationAddress": "2102 N COUNTRY CLUB RD",
"SecondLinePracticeLocationAddress": "SUITE 4",
"PracticeLocationAddressCityName": "TUCSON",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85716-2831",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "520-325-6633",
"PracticeLocationAddressFaxNumber": "520-325-6644",
"EnumerationDate": "03/15/2007",
"LastUpdateDate": "04/20/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LONGORIA",
"AuthorizedOfficialFirstName": "TERESA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "520-325-6633",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "18725",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}