{
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"FirstLineMailingAddress": "101 W MISSION BLVD",
"SecondLineMailingAddress": "110-141",
"MailingAddressCityName": "POMONA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91766-1711",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-649-7261",
"MailingAddressFaxNumber": "909-796-2537",
"FirstLinePracticeLocationAddress": "375 S MAIN ST",
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"EnumerationDate": "10/20/2010",
"LastUpdateDate": "10/20/2010",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "WIGGINS",
"AuthorizedOfficialFirstName": "SHIRLEY",
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"Taxonomies": {
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"TaxonomyName": "Clinical Social Worker",
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"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}
}
}