{
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"EIN": null,
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"MailingAddressCityName": "RIVERSIDE",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "7160 BROCKTON AVE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-782-3859",
"PracticeLocationAddressFaxNumber": "951-332-8260",
"EnumerationDate": "05/10/2006",
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"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}