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General NPI Number Information
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NPI Number | 1316922040
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Entity Type | Organization
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Legal Business Name | HUNTINGTON OUTPATIENT SURGERY CENTER
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 797 S FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91105-2617
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Country | US
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Telephone | 626-535-2434
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Fax | 626-535-2430
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Provider Business Mailing Address
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Address Line | 797 S FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91105-2617
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Country | US
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Telephone | 626-535-2434
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Fax | 626-535-2430
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Authorized Official
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Title or Position | PRES,BOARD OF MANAGERS,MED DIRECTOR
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Name | ROBIN K WALDVOGEL
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Credential | MD
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Telephone | 626-535-2434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | CA
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