{
"Npi": {
"NPI": "1679951701",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROSALEDA DENTAL CARE,PSC",
"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": "350 VIA AVENTURA",
"SecondLineMailingAddress": "APT#6602 ENCANTADA",
"MailingAddressCityName": "TRUJILLO ALTO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00976-6184",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-701-2613",
"MailingAddressFaxNumber": "787-701-2613",
"FirstLinePracticeLocationAddress": "AL4 AVE FIDALGO DIAZ",
"SecondLinePracticeLocationAddress": "VILLA FONTANA",
"PracticeLocationAddressCityName": "CAROLINA",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00983-0983",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-701-2613",
"PracticeLocationAddressFaxNumber": "787-701-2613",
"EnumerationDate": "05/08/2015",
"LastUpdateDate": "05/08/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CABRERA",
"AuthorizedOfficialFirstName": "JEANETTE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "787-701-2613",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "2392",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}