{
"Npi": {
"NPI": "1962451724",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PADILLA MACHUCA",
"FirstName": "SAMUEL",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "REPARTO TERESITA",
"SecondLineMailingAddress": "C/30 AD-3",
"MailingAddressCityName": "BAYAMON",
"MailingAddressStateName": "RI",
"MailingAddressPostalCode": "00961-8343",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-466-3403",
"MailingAddressFaxNumber": "787-268-7271",
"FirstLinePracticeLocationAddress": "1845 BAYAMON MEDICAL PLAZA",
"SecondLinePracticeLocationAddress": "STE 509",
"PracticeLocationAddressCityName": "BAYAMON",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00960",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-786-9200",
"PracticeLocationAddressFaxNumber": "787-786-9700",
"EnumerationDate": "05/09/2006",
"LastUpdateDate": "12/11/2023",
"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": "207RN0300X",
"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "15949",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}