{
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"EIN": null,
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"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "PO BOX 90",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AGUADA",
"MailingAddressStateName": "PR",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-589-7400",
"MailingAddressFaxNumber": "787-589-7402",
"FirstLinePracticeLocationAddress": "CARR. 115 KM. 24.5",
"SecondLinePracticeLocationAddress": "BARRIO ASOMANTE",
"PracticeLocationAddressCityName": "AGUADA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-589-7400",
"PracticeLocationAddressFaxNumber": "787-589-7402",
"EnumerationDate": "11/18/2020",
"LastUpdateDate": "11/18/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ORTEGA",
"AuthorizedOfficialFirstName": "HIRAM",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "787-589-7400",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}