Healthcare Provider Details

I. General information

NPI: 1174796577
Provider Name (Legal Business Name): HUNTINGTON ASTHMA & ALLERGY CENTER A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 108
PASADENA CA
91106-2401
US

IV. Provider business mailing address

960 E GREEN ST STE 108
PASADENA CA
91106-2401
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-6680
  • Fax: 888-475-7784
Mailing address:
  • Phone: 626-793-6680
  • Fax: 888-475-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG15099
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA72638
License Number StateCA

VIII. Authorized Official

Name: REYNEIRO CASTRO
Title or Position: OWNER/MD
Credential: MD
Phone: 626-793-6680