{
"Npi": {
"NPI": "1609288133",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MADDIGRL LLC",
"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": "1248 ATWATER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHULA VISTA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91913-1453",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-934-7884",
"MailingAddressFaxNumber": "888-588-0942",
"FirstLinePracticeLocationAddress": "2880 WANEK RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ESCONDIDO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92027-2889",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-781-1027",
"PracticeLocationAddressFaxNumber": "888-588-0942",
"EnumerationDate": "06/02/2014",
"LastUpdateDate": "06/02/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MENDOZA",
"AuthorizedOfficialFirstName": "TEOFILO",
"AuthorizedOfficialMiddleName": "POSADAS",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "619-934-7884",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "315D00000X",
"TaxonomyName": "Inpatient Hospice",
"LicenseNumber": "374603045",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "374603045",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}