{
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"FirstLineMailingAddress": "PO BOX 742738",
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"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90074-2738",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "100 S SAN MATEO DR",
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"PracticeLocationAddressCityName": "SAN MATEO",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "650-696-5400",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/29/2016",
"LastUpdateDate": "12/06/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GATES",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "510-450-7357",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychiatric Hospital Unit",
"LicenseNumber": "220000037",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}