{
"Npi": {
"NPI": "1528144664",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHGATE ROSE PHARMACY 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": "8615 KNOTT AVE",
"SecondLineMailingAddress": "SUITE #7",
"MailingAddressCityName": "BUENA PARK",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90620-3841",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-952-4978",
"MailingAddressFaxNumber": "714-952-4978",
"FirstLinePracticeLocationAddress": "8615 KNOTT AVE",
"SecondLinePracticeLocationAddress": "SUITE #7",
"PracticeLocationAddressCityName": "BUENA PARK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90620-3841",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-952-4978",
"PracticeLocationAddressFaxNumber": "714-952-4978",
"EnumerationDate": "10/31/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RAMOS-ZAMORA",
"AuthorizedOfficialFirstName": "ROSSMARI",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "714-953-6861",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0005X",
"TaxonomyName": "Ambulatory Family Planning Facility",
"LicenseNumber": "PHY47605",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}