{
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"NPI": "1588161095",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CENTRO DE CIRUGIA PLASTICA Y OFTALMICA INC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 901",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CABO ROJO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00623-0901",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-805-3232",
"MailingAddressFaxNumber": "787-255-0707",
"FirstLinePracticeLocationAddress": "EDIF DRES COLBERG",
"SecondLinePracticeLocationAddress": "CARR 100 KM 5.2",
"PracticeLocationAddressCityName": "CABO ROJO",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00623",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-805-3232",
"PracticeLocationAddressFaxNumber": "787-255-0707",
"EnumerationDate": "04/11/2018",
"LastUpdateDate": "04/29/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUIZ",
"AuthorizedOfficialFirstName": "ROBERTO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MHSA",
"AuthorizedOfficialTelephoneNumber": "787-249-5097",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "32",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}