{
"Npi": {
"NPI": "1932124377",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CARRILLO",
"FirstName": "PETER",
"MiddleName": null,
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "PT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "38072 AMATEUR WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEAUMONT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92223-8086",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-489-5971",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2595 W FLORIDA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HEMET",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92545-4615",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-487-9317",
"PracticeLocationAddressFaxNumber": "951-487-9371",
"EnumerationDate": "07/13/2006",
"LastUpdateDate": "03/05/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT26426",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}