{
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"IsOrgSubpart": "N",
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 401721",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89140-1721",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-610-6353",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9465 W POST ROAD",
"SecondLinePracticeLocationAddress": "SUITE 1068",
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"PracticeLocationAddressTelephoneNumber": "562-587-6862",
"PracticeLocationAddressFaxNumber": "866-645-1202",
"EnumerationDate": "02/13/2014",
"LastUpdateDate": "02/13/2014",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AHMED",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Non-Pharmacy Dispensing Site",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}