{
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"OtherLastName": "HERNANDEZ",
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"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "15507 S NORMANDIE AVE # 143",
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"MailingAddressCityName": "GARDENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90247-4013",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-719-8428",
"MailingAddressFaxNumber": "323-345-5483",
"FirstLinePracticeLocationAddress": "24520 HAWTHORNE BLVD",
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"PracticeLocationAddressCityName": "TORRANCE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-719-8428",
"PracticeLocationAddressFaxNumber": "323-345-5483",
"EnumerationDate": "02/17/2007",
"LastUpdateDate": "02/16/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"AuthorizedOfficialFirstName": null,
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "51129",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}