{
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"FirstLineMailingAddress": "2031 MCDANIEL ST",
"SecondLineMailingAddress": "SUITE 230",
"MailingAddressCityName": "NORTH LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89030-6303",
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"MailingAddressTelephoneNumber": "702-649-7300",
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"FirstLinePracticeLocationAddress": "2031 MCDANIEL ST",
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"EnumerationDate": "08/08/2007",
"LastUpdateDate": "08/08/2007",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PENA",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
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"LicenseNumberStateCode": "NV",
"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."
}
}
}
}