{
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"FirstLineMailingAddress": "189 LIBERTY ST",
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"MailingAddressCityName": "TUSTIN",
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"FirstLinePracticeLocationAddress": "201 E. SANDPOINTE AVE",
"SecondLinePracticeLocationAddress": "SUITE 600",
"PracticeLocationAddressCityName": "SANTA ANA",
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"PracticeLocationAddressTelephoneNumber": "800-918-1215",
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"EnumerationDate": "05/03/2018",
"LastUpdateDate": "05/03/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
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"LicenseNumber": "95002340",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}