{
"Npi": {
"NPI": "1861635963",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CENTRO DE EVALUACION Y TERAPIA BRUNILDA VELAZQUEZ TORRES",
"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": "PO BOX 7505",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAGUAS",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00726-7505",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-375-7259",
"MailingAddressFaxNumber": "787-737-8437",
"FirstLinePracticeLocationAddress": "BORGONA STREET 3 B-3",
"SecondLinePracticeLocationAddress": "URB. VILLA DEL REY 3RD SECTION",
"PracticeLocationAddressCityName": "CAGUAS",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00725",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-375-7259",
"PracticeLocationAddressFaxNumber": "787-737-8437",
"EnumerationDate": "04/20/2009",
"LastUpdateDate": "04/20/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VELAZQUEZ TORRES",
"AuthorizedOfficialFirstName": "BRUNILDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS",
"AuthorizedOfficialTelephoneNumber": "787-375-7259",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "2312",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}