{
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"FirstLineMailingAddress": "1140 W LA VETA AVE",
"SecondLineMailingAddress": "#560",
"MailingAddressCityName": "ORANGE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92868-4223",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-835-0101",
"MailingAddressFaxNumber": "714-835-1133",
"FirstLinePracticeLocationAddress": "1140 W LA VETA AVE",
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"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressTelephoneNumber": "714-835-0101",
"PracticeLocationAddressFaxNumber": "714-835-1133",
"EnumerationDate": "01/09/2008",
"LastUpdateDate": "02/15/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CASSIDENTI",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "714-835-2344",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "C55330",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}