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1205988094 NPI number — HOUSE OF MEDICINE INC

NPI Number: 1205988094
Health Care Provider/Practitioner: HOUSE OF MEDICINE INC

Information about “1205988094” NPI (HOUSE OF MEDICINE INC) exists in 1205988094 in HTML format HTML  |  1205988094 in plain Text format TXT  |  1205988094 in PDF (Portable Document Format) PDF  |  1205988094 in an XML format XML  formats.

NPI Number : 1205988094 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205988094",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "HOUSE OF MEDICINE 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": "2530 BRENNEN WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FULLERTON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92835-4217",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1150 N HARBOR BLVD",
    "SecondLinePracticeLocationAddress": "STE 136",
    "PracticeLocationAddressCityName": "ANAHEIM",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92801-2400",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-520-9085",
    "PracticeLocationAddressFaxNumber": "714-517-0400",
    "EnumerationDate": "01/18/2007",
    "LastUpdateDate": "01/13/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LEBADA",
    "AuthorizedOfficialFirstName": "HAHMUD",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRES",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "714-520-9085",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "PHY44468",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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