{
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"FirstLineMailingAddress": "14384 NARCISSE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORONA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92880-1088",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9673 SIERRA AVE",
"SecondLinePracticeLocationAddress": "SUIT C",
"PracticeLocationAddressCityName": "FONTANA",
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"EnumerationDate": "05/01/2009",
"LastUpdateDate": "06/25/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORTES",
"AuthorizedOfficialFirstName": "CLAUDIA",
"AuthorizedOfficialMiddleName": "PATRICIA",
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"AuthorizedOfficialTelephoneNumber": "909-471-1186",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "57001",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}