{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2130 ENCHANTED PARK LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KATY",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77450-7126",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-660-3454",
"MailingAddressFaxNumber": "626-227-7622",
"FirstLinePracticeLocationAddress": "2130 ENCHANTED PARK LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KATY",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-660-3454",
"PracticeLocationAddressFaxNumber": "626-227-7622",
"EnumerationDate": "03/02/2026",
"LastUpdateDate": "03/02/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FALADE",
"AuthorizedOfficialFirstName": "CHRISTINE",
"AuthorizedOfficialMiddleName": "CHRISTINE",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "281-660-3454",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251X00000X",
"TaxonomyName": "Supports Brokerage Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}