Organization
HUNTINGTON MR CENTER A LIMITED PARTNERSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD V. PETRUS MD (MEDICAL DIRECTOR)
(626) 397-8661
Entity
Organization
Contact information
Practice address
10 PICO ST, PASADENA, CA 91105-3201
(626) 397-8661
(626) 397-5889
Mailing address
223 N 1ST AVE, SUITE #201, ARCADIA, CA 91006-7089
(626) 821-1411
(626) 821-0406
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EXE70069F
—
CA
01
—
ZZZ24574Z
BLUE SHIELD
CA
Enumeration date
05/18/2006
Last updated
10/25/2007
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