{
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"FirstLineMailingAddress": "3 HAMILTON LANDING #160",
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"MailingAddressCityName": "NOVATO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94949-4949",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "415-884-1840",
"MailingAddressFaxNumber": "415-884-3510",
"FirstLinePracticeLocationAddress": "3 HAMILTON LANDING #160",
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"PracticeLocationAddressCityName": "NOVATO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "415-884-1840",
"PracticeLocationAddressFaxNumber": "415-884-3510",
"EnumerationDate": "05/04/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CRISTE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "415-884-1840",
"Taxonomies": {
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"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}