{
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"FirstLineMailingAddress": "2046 HILLHURST AVE # 156",
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"MailingAddressPostalCode": "90027-2719",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "8929 S SEPULVEDA BLVD STE 412",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOS ANGELES",
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"PracticeLocationAddressTelephoneNumber": "310-505-6096",
"PracticeLocationAddressFaxNumber": "323-978-6919",
"EnumerationDate": "07/05/2023",
"LastUpdateDate": "01/10/2024",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "SPEER",
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"AuthorizedOfficialTelephoneNumber": "424-214-9647",
"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}