{
"Npi": {
"NPI": "1821090366",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VALLEY DIGESTIVE HEALTH CENTER",
"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": "1330 W COVINA BLVD",
"SecondLineMailingAddress": "SUITE 203",
"MailingAddressCityName": "SAN DIMAS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91773-3200",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-592-6157",
"MailingAddressFaxNumber": "909-592-1544",
"FirstLinePracticeLocationAddress": "488 E SANTA CLARA ST",
"SecondLinePracticeLocationAddress": "SUITE 102",
"PracticeLocationAddressCityName": "ARCADIA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91006-7229",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-359-9555",
"PracticeLocationAddressFaxNumber": "626-359-9556",
"EnumerationDate": "08/15/2005",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TARAKJI",
"AuthorizedOfficialFirstName": "ELIAS",
"AuthorizedOfficialMiddleName": "ALBERT",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "626-359-9555",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}