{
"Npi": {
"NPI": "1053098152",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PREP ED PROGRAMS INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2005 PALO VERDE AVE STE 251",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LONG BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90815-3322",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-270-4833",
"MailingAddressFaxNumber": "562-377-7961",
"FirstLinePracticeLocationAddress": "5150 CANDLEWOOD ST STE 22C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKEWOOD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90712-1929",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-270-4833",
"PracticeLocationAddressFaxNumber": "562-377-7961",
"EnumerationDate": "06/29/2023",
"LastUpdateDate": "05/10/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DILES",
"AuthorizedOfficialFirstName": "CLAUDE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "CMPSS #MPSS-LKXQFH",
"AuthorizedOfficialTelephoneNumber": "424-242-3087",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "172V00000X",
"TaxonomyName": "Community Health Worker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "175T00000X",
"TaxonomyName": "Peer Specialist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251V00000X",
"TaxonomyName": "Voluntary or Charitable Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "171M00000X",
"TaxonomyName": "Case Manager/Care Coordinator",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}