{
"Npi": {
"NPI": "1750606604",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LABORATORIO CLINICO CIBUCO INC",
"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": "710 CALLE COCATIER",
"SecondLineMailingAddress": "LOS MONTES",
"MailingAddressCityName": "DORADO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00646-9464",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-381-2732",
"MailingAddressFaxNumber": "787-875-3510",
"FirstLinePracticeLocationAddress": "CARRETERA 159",
"SecondLinePracticeLocationAddress": "KILOMETRO 7.5",
"PracticeLocationAddressCityName": "COROZAL",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00783",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-381-2732",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/05/2010",
"LastUpdateDate": "08/27/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SARRAGA",
"AuthorizedOfficialFirstName": "EVELYN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCDA",
"AuthorizedOfficialTelephoneNumber": "787-381-2732",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}