{
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"FirstLineMailingAddress": "7211 SAN LUCAS DR",
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"MailingAddressStateName": "TX",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "832-955-3125",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "13839 PURPLEMARTIN ST",
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"EnumerationDate": "08/12/2022",
"LastUpdateDate": "08/12/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAMBAKASA",
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"AuthorizedOfficialCredential": "C.N.A",
"AuthorizedOfficialTelephoneNumber": "832-955-3125",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}