{
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"FirstLineMailingAddress": "1717 E VISTA CHINO STE A7-492",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92262-3559",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "74000 COUNTRY CLUB DR",
"SecondLinePracticeLocationAddress": "SUITE G3",
"PracticeLocationAddressCityName": "PALM DESERT",
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"EnumerationDate": "05/03/2017",
"LastUpdateDate": "05/03/2017",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "PARDINO",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207XX0005X",
"TaxonomyName": "Sports Medicine (Orthopaedic Surgery) Physician",
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"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}