{
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"EIN": null,
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"LastName": "SEBASTIAN",
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"NamePrefix": null,
"NameSuffix": null,
"Credential": "IMF",
"OtherOrgName": null,
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"OtherLastName": "GUZMAN",
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"OtherCredential": "IMF",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "9825 MAGNOLIA AVE STE B",
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"MailingAddressCityName": "RIVERSIDE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92503-3565",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-509-2499",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1012 MAIN ST STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RAMONA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92065-2170",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-788-9724",
"PracticeLocationAddressFaxNumber": "760-788-9754",
"EnumerationDate": "08/15/2011",
"LastUpdateDate": "08/25/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "106H00000X",
"TaxonomyName": "Marriage & Family Therapist",
"LicenseNumber": "IMF 72695",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}