{
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"FirstLineMailingAddress": "9036 PULSAR CT STE H",
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"MailingAddressCityName": "CORONA",
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"MailingAddressPostalCode": "92883-7349",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-603-0031",
"MailingAddressFaxNumber": "951-603-0047",
"FirstLinePracticeLocationAddress": "9036 PULSAR CT STE H",
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"EnumerationDate": "01/16/2013",
"LastUpdateDate": "01/16/2013",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DORSEY",
"AuthorizedOfficialFirstName": "STACY",
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"AuthorizedOfficialCredential": "MFT",
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"LicenseNumber": "MFC32724",
"LicenseNumberStateCode": "CA",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}