{
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"FirstLineMailingAddress": "PO BOX 8726",
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"MailingAddressCityName": "PONCE",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00732-8726",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "2360 AVE EDUARDO RUBERTE",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/13/2014",
"LastUpdateDate": "06/27/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALVARADO DIAZ",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207XX0005X",
"TaxonomyName": "Sports Medicine (Orthopaedic Surgery) Physician",
"LicenseNumber": "16456",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}