{
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"FirstLineMailingAddress": "41511 E FLORIDA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HEMET",
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"MailingAddressPostalCode": "92544-5802",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-658-3227",
"MailingAddressFaxNumber": "951-652-6267",
"FirstLinePracticeLocationAddress": "41511 E FLORIDA AVE",
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"PracticeLocationAddressTelephoneNumber": "951-658-3227",
"PracticeLocationAddressFaxNumber": "951-652-6267",
"EnumerationDate": "08/07/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCKENZIE",
"AuthorizedOfficialFirstName": "STEPHEN",
"AuthorizedOfficialMiddleName": "E",
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"AuthorizedOfficialCredential": "M.D.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "A054049",
"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."
}
}
}
}