{
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9451 FRITZ ST",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/06/2025",
"LastUpdateDate": "04/19/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAYAN VILLA",
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"Taxonomies": {
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"TaxonomyName": "Private Vehicle",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}