{
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"OrgName": "L. A PRIMARY CARE & SPECIALTY GROUP, LLC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 11395",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN JUAN",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00922-1395",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-226-6359",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "100 CALLE DEL MUELLE",
"SecondLinePracticeLocationAddress": "CAPITOLIO PLAZA TORRE 1 1503",
"PracticeLocationAddressCityName": "SAN JUAN",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00901-2616",
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"PracticeLocationAddressTelephoneNumber": "787-226-6359",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/06/2016",
"LastUpdateDate": "07/06/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOPEZ ACOSTA",
"AuthorizedOfficialFirstName": "RAMON",
"AuthorizedOfficialMiddleName": "LUIS",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "787-226-6359",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "09645",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}