{
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"FirstLineMailingAddress": "PO BOX 801293",
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"MailingAddressCityName": "COTO LAUREL",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00780-1293",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "25 CALLE LEPANTO",
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"PracticeLocationAddressCityName": "SAN JUAN",
"PracticeLocationAddressStateName": "PR",
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"EnumerationDate": "10/02/2009",
"LastUpdateDate": "10/02/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MUNDO",
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"AuthorizedOfficialTelephoneNumber": "787-717-5655",
"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}