Provider Demographics
NPI:1700839313
Name:HUNTINGTON MR CENTER A LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:HUNTINGTON MR CENTER A LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:PETRUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-397-8661
Mailing Address - Street 1:223 N 1ST AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7089
Mailing Address - Country:US
Mailing Address - Phone:626-821-1411
Mailing Address - Fax:626-821-0406
Practice Address - Street 1:10 PICO ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3201
Practice Address - Country:US
Practice Address - Phone:626-397-8661
Practice Address - Fax:626-397-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24574ZOtherBLUE SHIELD
CAEXE70069FMedicaid
CAEXE70069FMedicaid