{
"Npi": {
"NPI": "1114039385",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SNF OXYGEN SERVICESLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1107 FAIR OAKS AVE",
"SecondLineMailingAddress": "STE 528",
"MailingAddressCityName": "SOUTH PASADENA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91030-3311",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-270-5207",
"MailingAddressFaxNumber": "951-898-9991",
"FirstLinePracticeLocationAddress": "240 OTT ST",
"SecondLinePracticeLocationAddress": "N/A",
"PracticeLocationAddressCityName": "CORONA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92882-1872",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-270-5207",
"PracticeLocationAddressFaxNumber": "951-898-9991",
"EnumerationDate": "08/31/2006",
"LastUpdateDate": "09/06/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABACHERLI",
"AuthorizedOfficialFirstName": "GERRY",
"AuthorizedOfficialMiddleName": "SUE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "N/A",
"AuthorizedOfficialTelephoneNumber": "951-270-5207",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BX2000X",
"TaxonomyName": "Oxygen Equipment & Supplies (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}