{
"Npi": {
"NPI": "1326158528",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BONES MANAGEMENT, 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": "14241 FIRESTONE BLVD",
"SecondLineMailingAddress": "SUITE 320",
"MailingAddressCityName": "LA MIRADA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90638-5530",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-407-9338",
"MailingAddressFaxNumber": "562-407-9340",
"FirstLinePracticeLocationAddress": "210 S GRAND AVE",
"SecondLinePracticeLocationAddress": "SUITE 116",
"PracticeLocationAddressCityName": "GLENDORA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91741-4205",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-335-2300",
"PracticeLocationAddressFaxNumber": "626-914-0713",
"EnumerationDate": "08/30/2006",
"LastUpdateDate": "03/26/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GLOBERMAN",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "562-407-9338",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY34719",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}