Healthcare Provider Details

I. General information

NPI: 1811743131
Provider Name (Legal Business Name): HUMANGOOD SOCAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1763 ROYAL OAKS DR
DUARTE CA
91010-1970
US

IV. Provider business mailing address

1900 HUNTINGTON DR
DUARTE CA
91010-2694
US

V. Phone/Fax

Practice location:
  • Phone: 925-924-7100
  • Fax:
Mailing address:
  • Phone: 925-924-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW JAMES MCDONALD
Title or Position: CFO
Credential:
Phone: 925-924-7196