{
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"FirstLineMailingAddress": "101 SUN AVE NE",
"SecondLineMailingAddress": "COMPLIANCE DEPARTMENT",
"MailingAddressCityName": "ALBUQUERQUE",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-468-5604",
"MailingAddressFaxNumber": "505-468-4681",
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"EnumerationDate": "08/23/2006",
"LastUpdateDate": "03/15/2015",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIVITTORIO",
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"AuthorizedOfficialTelephoneNumber": "505-468-4742",
"Taxonomies": {
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}
},
"HealthcareProviderTaxonomyGroups": null
}
}