{
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"FirstLineMailingAddress": "1359 N MOUNT VERNON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLTON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92324-2561",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-370-0335",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1359 N MOUNT VERNON AVE",
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"PracticeLocationAddressTelephoneNumber": "909-370-0335",
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"EnumerationDate": "07/12/2006",
"LastUpdateDate": "12/14/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AMUDIPE",
"AuthorizedOfficialFirstName": "WILLIAM",
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"AuthorizedOfficialCredential": "DME",
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"Taxonomies": {
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"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "DME02460F",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}