{
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"IsOrgSubpart": "N",
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"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 452121",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90045-8527",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-807-1614",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3553 S WESTERN AVE",
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"PracticeLocationAddressCityName": "LOS ANGELES",
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"PracticeLocationAddressTelephoneNumber": "310-807-1614",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/19/2012",
"LastUpdateDate": "03/19/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DE LA CRUZ HAASLER",
"AuthorizedOfficialFirstName": "SHERY",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "310-807-1614",
"Taxonomies": {
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"TaxonomyName": "Private Vehicle",
"LicenseNumber": null,
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}