{
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"EIN": null,
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "9960 CAMPO RD",
"SecondLineMailingAddress": "105",
"MailingAddressCityName": "SPRING VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91977-1605",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-222-2244",
"MailingAddressFaxNumber": "619-222-2843",
"FirstLinePracticeLocationAddress": "9960 CAMPO RD",
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"PracticeLocationAddressCityName": "SPRING VALLEY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-222-2244",
"PracticeLocationAddressFaxNumber": "619-222-2843",
"EnumerationDate": "07/25/2006",
"LastUpdateDate": "03/20/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIBSON",
"AuthorizedOfficialFirstName": "GREGORY",
"AuthorizedOfficialMiddleName": "LYDELL",
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"AuthorizedOfficialTelephoneNumber": "619-222-2244",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Ambulance",
"LicenseNumber": "1867",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}