{
"Npi": {
"NPI": "1205106309",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCE MEDICAL SUPPLY",
"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": "441 E WHITTIER BLVD",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "LA HABRA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90631-3982",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-846-4842",
"MailingAddressFaxNumber": "562-846-4829",
"FirstLinePracticeLocationAddress": "441 E WHITTIER BLVD",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "LA HABRA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90631-3982",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-846-4842",
"PracticeLocationAddressFaxNumber": "562-846-4829",
"EnumerationDate": "01/05/2012",
"LastUpdateDate": "04/20/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAGANA",
"AuthorizedOfficialFirstName": "LUIS",
"AuthorizedOfficialMiddleName": "RICARDO",
"AuthorizedOfficialTitle": "OWNER/PARTNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "562-846-4842",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "102074190",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}