{
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "2625 W ALAMEDA AVE",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-841-0423",
"MailingAddressFaxNumber": "818-841-1508",
"FirstLinePracticeLocationAddress": "2625 W ALAMEDA AVE",
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"EnumerationDate": "03/19/2007",
"LastUpdateDate": "04/07/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHALTS",
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"AuthorizedOfficialCredential": "PHARM D",
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"Taxonomies": {
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{
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"PrimaryTaxonomySwitch": "N"
},
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},
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}