{
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"FirstLineMailingAddress": "330 SIXTH STREET",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-793-7788",
"MailingAddressFaxNumber": "909-793-2288",
"FirstLinePracticeLocationAddress": "330 6TH ST STE 201",
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"PracticeLocationAddressCityName": "REDLANDS",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/01/2008",
"LastUpdateDate": "12/05/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRIDGEWATER",
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"AuthorizedOfficialTelephoneNumber": "909-793-7788",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}