{
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"EIN": null,
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"OrgName": null,
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"FirstLineMailingAddress": "PO BOX 94",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAROLINA",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00986-0094",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-776-3511",
"MailingAddressFaxNumber": "787-757-2039",
"FirstLinePracticeLocationAddress": "AVENIDA JOSE FIDALGO DIAZ",
"SecondLinePracticeLocationAddress": "4SS6 VILLA FONTANA",
"PracticeLocationAddressCityName": "CAROLINA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-776-3511",
"PracticeLocationAddressFaxNumber": "787-757-2039",
"EnumerationDate": "12/14/2021",
"LastUpdateDate": "12/14/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332S00000X",
"TaxonomyName": "Hearing Aid Equipment",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}