{
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"EIN": null,
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"FirstLineMailingAddress": "22622 LAMBERT ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKE FOREST",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92630-1609",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-768-4327",
"MailingAddressFaxNumber": "949-768-4009",
"FirstLinePracticeLocationAddress": "22622 LAMBERT ST",
"SecondLinePracticeLocationAddress": "301#B",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-768-4327",
"PracticeLocationAddressFaxNumber": "949-768-4009",
"EnumerationDate": "10/03/2008",
"LastUpdateDate": "10/03/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Contractor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}