{
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"FirstLineMailingAddress": "790 NE 121ST ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BISCAYNE PARK",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33161-6363",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "305-891-3175",
"FirstLinePracticeLocationAddress": "527 NE 124TH ST",
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"PracticeLocationAddressCityName": "NORTH MIAMI",
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"PracticeLocationAddressTelephoneNumber": "305-891-0045",
"PracticeLocationAddressFaxNumber": "305-891-3175",
"EnumerationDate": "05/17/2006",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "ME91465",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}