Healthcare Provider Details

I. General information

NPI: 1194113803
Provider Name (Legal Business Name): HUNTINGTON PULMONARY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CONGRESS ST SUITE 201
PASADENA CA
91105-3024
US

IV. Provider business mailing address

39 CONGRESS ST SUITE 201
PASADENA CA
91105-3024
US

V. Phone/Fax

Practice location:
  • Phone: 626-486-0181
  • Fax: 626-486-0189
Mailing address:
  • Phone: 626-486-0181
  • Fax: 626-486-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA97268
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA102461
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA82228
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA88722
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA82228
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA102461
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA97268
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA82228
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA88722
License Number StateCA

VIII. Authorized Official

Name: JIMI M GONZALEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-316-7026