{
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"LastName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "20601 TIARA ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODLAND HILLS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91367-5324",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "18321 CLARK ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TARZANA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressTelephoneNumber": "818-881-0800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/04/2026",
"LastUpdateDate": "06/04/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIBISCEGLIE",
"AuthorizedOfficialFirstName": "FRANK",
"AuthorizedOfficialMiddleName": "WILLIAM",
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"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "917-538-3384",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}