Healthcare Provider Details

I. General information

NPI: 1649166281
Provider Name (Legal Business Name): UNITED THERANOSTICS PHYSICIANS OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 W OLYMPIC BLVD STE 610
LOS ANGELES CA
90064-1527
US

IV. Provider business mailing address

8300 NORMAN CENTER DR
MINNEAPOLIS MN
55437-1027
US

V. Phone/Fax

Practice location:
  • Phone: 443-333-1894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number
License Number State

VIII. Authorized Official

Name: PEGGY LOUISE STRAUGHAN
Title or Position: RCM
Credential: RCM
Phone: 301-450-2095