{
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"FirstLineMailingAddress": "6235 JOSIE ST",
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"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "6235 JOSIE STREET",
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"EnumerationDate": "06/29/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PITCOCK",
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"AuthorizedOfficialMiddleName": "MARIE",
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"Taxonomies": {
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"TaxonomyName": "Transportation Broker",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}