Healthcare Provider Details

I. General information

NPI: 1295204113
Provider Name (Legal Business Name): HUNTINGTON SPECIALTY SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CONGRESS ST STE 310
PASADENA CA
91105-3024
US

IV. Provider business mailing address

39 CONGRESS ST STE 310
PASADENA CA
91105-3024
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VAHE PANOSSIAN
Title or Position: DIRECTOR
Credential:
Phone: 626-795-0282