{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "SARATOGA WALK IN CLINIC",
"LastName": null,
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"NameSuffix": null,
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"FirstLineMailingAddress": "14054 ALTA VISTA AVENUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SARATOGA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95070",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "408-867-1007",
"MailingAddressFaxNumber": "408-867-4459",
"FirstLinePracticeLocationAddress": "12224 SARATOGA SUNNYVALE ROAD",
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"PracticeLocationAddressCityName": "SARATOGA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "408-446-4774",
"PracticeLocationAddressFaxNumber": "408-446-9422",
"EnumerationDate": "05/25/2007",
"LastUpdateDate": "02/01/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WETTERHOLT",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "OWNER MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "408-446-4774",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "G24402",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}