{
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"IsOrgSubpart": "N",
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"NamePrefix": null,
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"FirstLineMailingAddress": "1140 W 50TH ST",
"SecondLineMailingAddress": "SUITE 400B",
"MailingAddressCityName": "HIALEAH",
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"MailingAddressPostalCode": "33012-3440",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-888-2006",
"MailingAddressFaxNumber": "305-888-2007",
"FirstLinePracticeLocationAddress": "1140 W 50TH ST",
"SecondLinePracticeLocationAddress": "SUITE 400B",
"PracticeLocationAddressCityName": "HIALEAH",
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"PracticeLocationAddressTelephoneNumber": "305-888-2006",
"PracticeLocationAddressFaxNumber": "305-888-2007",
"EnumerationDate": "08/22/2013",
"LastUpdateDate": "08/22/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIAZ",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "305-888-2006",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
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"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}