{
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"EIN": null,
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "4900 N 31ST CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOLLYWOOD",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33021-2306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-982-7736",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7219 W OAKLAND PARK BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAUDERHILL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-982-7732",
"PracticeLocationAddressFaxNumber": "954-982-7734",
"EnumerationDate": "01/31/2026",
"LastUpdateDate": "01/31/2026",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HESLER",
"AuthorizedOfficialFirstName": "DAMIEN",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialTelephoneNumber": "619-629-1771",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Primary Care Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}