{
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"OrgName": "HUMANGOOD SOCAL",
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"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "1900 HUNTINGTON DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DUARTE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91010-2694",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-247-0420",
"MailingAddressFaxNumber": "949-528-2434",
"FirstLinePracticeLocationAddress": "7450 OLIVETAS AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LA JOLLA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "858-454-4201",
"PracticeLocationAddressFaxNumber": "858-450-5298",
"EnumerationDate": "05/12/2008",
"LastUpdateDate": "06/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VANGELISTO",
"AuthorizedOfficialFirstName": "GWEN",
"AuthorizedOfficialMiddleName": "ELLEN",
"AuthorizedOfficialTitle": "DIRECTOR OF ACCOUNTS RECEIVABLE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "949-463-0893",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": "080000109",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}