{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DAISY MEDINA HERNANDEZ",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 494",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "QUEBRADILLAS",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00678-0494",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-210-2463",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "CARR 113 KM 11.8 INT",
"SecondLinePracticeLocationAddress": "700 CALLE SUSANO LA SALLE",
"PracticeLocationAddressCityName": "QUEBRADILLAS",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00678-2475",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-210-2463",
"PracticeLocationAddressFaxNumber": "787-395-7905",
"EnumerationDate": "01/08/2010",
"LastUpdateDate": "06/02/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEDINA HERNANDEZ",
"AuthorizedOfficialFirstName": "DAISY",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "787-210-2463",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "TC AMB 631",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}