Provider Demographics
NPI:1912084377
Name:HUNTINGTON REPRODUCTIVE CENTER MEDICAL GROUP
Entity Type:Organization
Organization Name:HUNTINGTON REPRODUCTIVE CENTER MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HACHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-440-9161
Mailing Address - Street 1:333 S ARROYO PKWY
Mailing Address - Street 2:3RD FLR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2515
Mailing Address - Country:US
Mailing Address - Phone:626-440-9161
Mailing Address - Fax:626-440-1565
Practice Address - Street 1:333 S ARROYO PKWY
Practice Address - Street 2:3RD FLR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2515
Practice Address - Country:US
Practice Address - Phone:626-440-9161
Practice Address - Fax:626-440-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty