{
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"IsOrgSubpart": "N",
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"OrgName": "DEJA VU MEDSPA",
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"FirstLineMailingAddress": "38 E HUNTINGTON DR",
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"MailingAddressStateName": "CA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-696-0049",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "38 E HUNTINGTON DR",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/13/2018",
"LastUpdateDate": "04/13/2018",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BEAUCLAIR",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
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"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "G17614",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}