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General NPI Number Information
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NPI Number | 1851568596
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Entity Type | Organization
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Legal Business Name | HUMANGOOD SOCAL
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 7450 OLIVETAS AVE
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City | LA JOLLA
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State | CA
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Zip | 92037
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Country | US
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Telephone | 858-454-4201
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Fax | 858-450-5298
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Provider Business Mailing Address
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Address Line | 1900 HUNTINGTON DR
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City | DUARTE
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State | CA
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Zip | 91010-2694
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Country | US
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Telephone | 818-247-0420
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Fax | 949-528-2434
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Authorized Official
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Title or Position | DIRECTOR OF ACCOUNTS RECEIVABLE
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Name | GWEN ELLEN VANGELISTO
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Credential |
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Telephone | 949-463-0893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 080000109
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License Number State | CA
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