{
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"OrgName": "CARRERA PROFESSINAL SERVICES PLLC",
"LastName": null,
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"FirstLineMailingAddress": "PO BOX 34795",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89133-4795",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-220-9865",
"MailingAddressFaxNumber": "702-251-8196",
"FirstLinePracticeLocationAddress": "3150 N TENAYA WAY",
"SecondLinePracticeLocationAddress": "SUITE 525",
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89128-0443",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-220-9865",
"PracticeLocationAddressFaxNumber": "702-251-8196",
"EnumerationDate": "09/10/2009",
"LastUpdateDate": "04/15/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARRERA",
"AuthorizedOfficialFirstName": "ELADIO",
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"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "702-862-9992",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RG0100X",
"TaxonomyName": "Gastroenterology Physician",
"LicenseNumber": "5165",
"LicenseNumberStateCode": "NV",
"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."
}
}
}
}