{
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"FirstLineMailingAddress": "7924 WOODMAN AVE UNIT 12",
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"MailingAddressCityName": "PANORAMA CITY",
"MailingAddressStateName": "CA",
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"FirstLinePracticeLocationAddress": "1924 ALCOA HWY",
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"PracticeLocationAddressCityName": "KNOXVILLE",
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"EnumerationDate": "03/25/2020",
"LastUpdateDate": "08/08/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"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."
}
}
}
}