{
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"FirstLineMailingAddress": "175 PARK ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKEPORT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95453-4803",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-263-9595",
"MailingAddressFaxNumber": "707-263-5576",
"FirstLinePracticeLocationAddress": "175 PARK ST",
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"PracticeLocationAddressCityName": "LAKEPORT",
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"PracticeLocationAddressFaxNumber": "707-263-5576",
"EnumerationDate": "11/28/2012",
"LastUpdateDate": "04/30/2013",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SILVA",
"AuthorizedOfficialFirstName": "TONIA",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "707-263-9595",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "E4562",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}