{
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"FirstLineMailingAddress": "265 W. SONORA PLACE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLAREMONT",
"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1900 ROYALTY DRIVE, SUITE 210",
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"PracticeLocationAddressCityName": "POMONA",
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"PracticeLocationAddressTelephoneNumber": "909-568-6816",
"PracticeLocationAddressFaxNumber": "909-629-2694",
"EnumerationDate": "04/03/2009",
"LastUpdateDate": "09/14/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAYES",
"AuthorizedOfficialFirstName": "ANDREA",
"AuthorizedOfficialMiddleName": "MICHELLE",
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"AuthorizedOfficialCredential": "M.S. CCC",
"AuthorizedOfficialTelephoneNumber": "909-641-3776",
"Taxonomies": {
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{
"TaxonomyCode": "335E00000X",
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}