{
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"FirstLineMailingAddress": "7227 VAN NUYS BLVD.",
"SecondLineMailingAddress": "UNIT B",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-736-6638",
"MailingAddressFaxNumber": "818-736-6658",
"FirstLinePracticeLocationAddress": "7227 VAN NUYS BLVD.",
"SecondLinePracticeLocationAddress": "UNIT B",
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"PracticeLocationAddressFaxNumber": "818-736-6658",
"EnumerationDate": "03/19/2021",
"LastUpdateDate": "11/09/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELDIB",
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"AuthorizedOfficialCredential": null,
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}