{
"Npi": {
"NPI": "1700817574",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARILL",
"FirstName": "CARLOS",
"MiddleName": "MIGUEL",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D., P.A.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5975 SUNSET DRIVE",
"SecondLineMailingAddress": "PENTHOUSE 802",
"MailingAddressCityName": "MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33143",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-497-2880",
"MailingAddressFaxNumber": "786-497-2881",
"FirstLinePracticeLocationAddress": "6280 SUNSET DR STE 400",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTH MIAMI",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33143-4860",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "786-497-2880",
"PracticeLocationAddressFaxNumber": "786-497-2881",
"EnumerationDate": "07/06/2006",
"LastUpdateDate": "05/01/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "ME44925",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}