Healthcare Provider Details

I. General information

NPI: 1851465603
Provider Name (Legal Business Name): HUNTINGTON ORTHOPEDIC SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CONGRESS ST STE 200
PASADENA CA
91105
US

IV. Provider business mailing address

39 CONGRESS ST STE 200
PASADENA CA
91105-3024
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-0282
  • Fax: 626-795-0585
Mailing address:
  • Phone: 626-795-0282
  • Fax: 626-795-0585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberFNP31122
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA66450
License Number StateCA

VIII. Authorized Official

Name: BIRDI SIERRA
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-795-0282