Healthcare Provider Details

I. General information

NPI: 1912378324
Provider Name (Legal Business Name): HUNTINGTON SPECIALIST & NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 S MYRTLE AVE 101
MONROVIA CA
91016-2825
US

IV. Provider business mailing address

PO BOX 1849
MONROVIA CA
91017-5849
US

V. Phone/Fax

Practice location:
  • Phone: 626-408-5927
  • Fax:
Mailing address:
  • Phone: 626-408-5927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL DEMARCO
Title or Position: OWNER
Credential: NP
Phone: 626-408-5927