{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LISBETH ROBLES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "644 E SAN YSIDRO BLVD. STE G-752",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN YSIDRO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92173",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-349-6409",
"MailingAddressFaxNumber": "619-354-2449",
"FirstLinePracticeLocationAddress": "JOSE MARIA LARROQUE #375-2",
"SecondLinePracticeLocationAddress": "COL. FEDERAL",
"PracticeLocationAddressCityName": "TIJUANA",
"PracticeLocationAddressStateName": "BC",
"PracticeLocationAddressPostalCode": "22010",
"PracticeLocationAddressCountryCode": "MX",
"PracticeLocationAddressTelephoneNumber": "619-349-6409",
"PracticeLocationAddressFaxNumber": "619-354-2449",
"EnumerationDate": "02/06/2025",
"LastUpdateDate": "02/06/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROBLES",
"AuthorizedOfficialFirstName": "LISBETH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "619-349-6409",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}