{
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"FirstLineMailingAddress": "4090 N MARTIN LUTHER KING",
"SecondLineMailingAddress": "SUITE 100",
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"FirstLinePracticeLocationAddress": "1111 N DECATUR BLVD",
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"PracticeLocationAddressCityName": "LAS VEGAS",
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"PracticeLocationAddressTelephoneNumber": "702-636-5553",
"PracticeLocationAddressFaxNumber": "844-318-0949",
"EnumerationDate": "07/29/2015",
"LastUpdateDate": "09/29/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}