Healthcare Provider Details

I. General information

NPI: 1679562680
Provider Name (Legal Business Name): LEONARD V. PETRUS MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

223 N 1ST AVE STE 101
ARCADIA CA
91006-7027
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5139
  • Fax: 626-397-2190
Mailing address:
  • Phone: 626-698-7246
  • Fax: 626-698-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA52292
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberA52292
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA52292
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA52292
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA52292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: