{
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "813 S ADAMS ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLENDALE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91205-2527",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-415-3827",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "822 S ROBERTSON BLVD",
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"PracticeLocationAddressCityName": "LOS ANGELES",
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"PracticeLocationAddressTelephoneNumber": "310-651-6937",
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"EnumerationDate": "09/14/2020",
"LastUpdateDate": "09/14/2020",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRUVER",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
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"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}