{
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"FirstLineMailingAddress": "JARDINES FAGOT 15",
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"MailingAddressStateName": "PR",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-840-3435",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15 CALLE JARDINES",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/22/2013",
"LastUpdateDate": "05/22/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GLENDA",
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"AuthorizedOfficialMiddleName": "E",
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"AuthorizedOfficialCredential": "O",
"AuthorizedOfficialTelephoneNumber": "787-630-8288",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Dentist",
"LicenseNumber": "2871",
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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."
}
}
}
}