{
"Npi": {
"NPI": "1629405287",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EMBATA CORP.",
"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": "J 6 CALLE 2 URB. BRISAS DEL MAR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LUQUILLO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00773",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-355-1222",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6410 AVE ISLA VERDE APT 4 L ESTE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CAROLINA",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00979",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-373-9664",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/27/2013",
"LastUpdateDate": "09/27/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOYECHEA",
"AuthorizedOfficialFirstName": "MIGUEL",
"AuthorizedOfficialMiddleName": "JUAN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "787373966466",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "13819",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}