{
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"FirstLineMailingAddress": "2417 PASEO LOS GATOS",
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"FirstLinePracticeLocationAddress": "675 E BRADLEY AVE",
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"PracticeLocationAddressCityName": "EL CAJON",
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"EnumerationDate": "11/11/2025",
"LastUpdateDate": "11/11/2025",
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Licensed Vocational Nurse",
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"LicenseNumberStateCode": "CA",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}