Healthcare Provider Details

I. General information

NPI: 1700839313
Provider Name (Legal Business Name): HUNTINGTON MR CENTER A LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PICO ST
PASADENA CA
91105-3201
US

IV. Provider business mailing address

223 N 1ST AVE SUITE #201
ARCADIA CA
91006-7089
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-8661
  • Fax: 626-397-5889
Mailing address:
  • Phone: 626-821-1411
  • Fax: 626-821-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEONARD V. PETRUS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 626-397-8661