{
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"FirstLineMailingAddress": "146 GLORY LN",
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"MailingAddressStateName": "NM",
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"FirstLinePracticeLocationAddress": "130 SIRINGO RD",
"SecondLinePracticeLocationAddress": "SUITE 201",
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"PracticeLocationAddressStateName": "NM",
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"PracticeLocationAddressTelephoneNumber": "505-989-3236",
"PracticeLocationAddressFaxNumber": "505-989-5079",
"EnumerationDate": "03/19/2015",
"LastUpdateDate": "03/19/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAMPOS SANDOVAL",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "505-603-8099",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
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},
{
"TaxonomyCode": "363LF0000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
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},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
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}
]
}
}
}