{
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"FirstLineMailingAddress": "1430 TARA HILLS DR",
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"MailingAddressFaxNumber": "510-640-0021",
"FirstLinePracticeLocationAddress": "1430 TARA HILLS DR",
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"EnumerationDate": "01/08/2016",
"LastUpdateDate": "02/04/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OLSEN",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "510-734-0677",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "C28611",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}