{
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"IsOrgSubpart": "N",
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"FirstName": null,
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"FirstLineMailingAddress": "12385 JOLETTE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRANADA HILLS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91344-1633",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-221-5222",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "854 JACKMAN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EL CAJON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92020-3053",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-404-5005",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/03/2021",
"LastUpdateDate": "05/03/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REZKWA",
"AuthorizedOfficialFirstName": "HAMBARSOOM",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialTelephoneNumber": "818-404-5005",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}