{
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"FirstLineMailingAddress": "11110 OHIO AVE",
"SecondLineMailingAddress": "SUITE 108",
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"FirstLinePracticeLocationAddress": "11110 OHIO AVE",
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"PracticeLocationAddressFaxNumber": "310-473-5077",
"EnumerationDate": "05/31/2013",
"LastUpdateDate": "06/30/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CONTRERAS",
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"Taxonomies": {
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}