{
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"EIN": null,
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"ParentOrgLBN": null,
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"OrgName": "SERGIO LOPEZ SOBA",
"LastName": null,
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"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "5220 CALLE LORENCITA FERRER",
"SecondLineMailingAddress": "EL TUQUE",
"MailingAddressCityName": "PONCE",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00728-4832",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-219-9207",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "COND TABAIBA GDNS",
"SecondLinePracticeLocationAddress": "AVE HUNGRIA 276",
"PracticeLocationAddressCityName": "PONCE",
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"PracticeLocationAddressPostalCode": "00716-1384",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-219-9207",
"PracticeLocationAddressFaxNumber": "787-843-0376",
"EnumerationDate": "12/06/2010",
"LastUpdateDate": "03/03/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOPEZ SOBA",
"AuthorizedOfficialFirstName": "SERGIO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DUENO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "787-219-9207",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "2677CP",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}