Healthcare Provider Details

I. General information

NPI: 1780766758
Provider Name (Legal Business Name): HUNTINGTON RADIATION MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST CALIFORNIA BOULEVARD
PASADENA CA
91109
US

IV. Provider business mailing address

100 WEST CALIFORNIA BOULEVARD
PASADENA CA
91109
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5149
  • Fax: 626-397-2147
Mailing address:
  • Phone: 626-397-5149
  • Fax: 626-397-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG70785
License Number StateCA

VIII. Authorized Official

Name: DR. RUTH CHANDLER WILLIAMSON
Title or Position: RADIATION ONCOLOGIST
Credential: M.D.
Phone: 626-397-5149