{
"Npi": {
"NPI": "1932073582",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JIMENEZ DE VIVIECA",
"FirstName": "LEIDYS",
"MiddleName": "MIRIANNY",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "SA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9175 SW 63RD CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PINECREST",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33156-1854",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-681-3548",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9175 SW 63RD CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PINECREST",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33156-1854",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "786-681-3548",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/06/2025",
"LastUpdateDate": "10/06/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "246ZC0007X",
"TaxonomyName": "Surgical Assistant",
"LicenseNumber": "25-424",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}