Organization
J. BRUCE JACOBS, MD, INC
Active
Other names
HUNTINGTON RADIOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER USMANOV M.D. (PRESIDENT)
(323) 584-3334
Entity
Organization
Contact information
Practice address
2680 SATURN AVE, SUITE 100, HUNTINGTON PARK, CA 90255-4377
(323) 584-3334
(323) 584-3336
Mailing address
2680 SATURN AVE, SUITE 100, HUNTINGTON PARK, CA 90255-4377
(323) 584-3334
(323) 584-3336
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A21604
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215230008
—
CA
Enumeration date
12/16/2010
Last updated
01/28/2014
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