{
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"FirstLineMailingAddress": "1155 MCNUTT RD STE 104",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1155 MCNUTT RD STE 104",
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"PracticeLocationAddressCityName": "SUNLAND PARK",
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"EnumerationDate": "03/30/2022",
"LastUpdateDate": "01/25/2023",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VILLA",
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"AuthorizedOfficialCredential": "ANP-BC",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}