{
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"IsOrgSubpart": "N",
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"OrgName": "NOT APPLICABLE",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "1820 FEATHERBROOK AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89031-5052",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-900-1489",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2008 HAMILTON LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89106-4033",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-900-1489",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/17/2019",
"LastUpdateDate": "10/11/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JONES",
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"AuthorizedOfficialTitle": "OFFICE MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "702-350-1060",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}