{
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"FirstLineMailingAddress": "1705 E DEL MAR BLVD STE A125",
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"MailingAddressStateName": "TX",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1705 E DEL MAR BLVD STE A125",
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"EnumerationDate": "09/15/2017",
"LastUpdateDate": "09/15/2017",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARIBI",
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"AuthorizedOfficialCredential": "ABOC",
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"Taxonomies": {
"Taxonomy": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}