{
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"FirstLineMailingAddress": "4271 UPTOWN NEWPORT DR UNIT 1",
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"MailingAddressTelephoneNumber": "714-657-5777",
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"FirstLinePracticeLocationAddress": "9648 QUAKERTOWN AVE",
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"EnumerationDate": "07/07/2025",
"LastUpdateDate": "07/07/2025",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "FORTADES",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}