Provider Demographics
NPI:1194113803
Name:HUNTINGTON PULMONARY MEDICAL GROUP
Entity type:Organization
Organization Name:HUNTINGTON PULMONARY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-316-7026
Mailing Address - Street 1:39 CONGRESS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3024
Mailing Address - Country:US
Mailing Address - Phone:626-486-0181
Mailing Address - Fax:626-486-0189
Practice Address - Street 1:39 CONGRESS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3024
Practice Address - Country:US
Practice Address - Phone:626-486-0181
Practice Address - Fax:626-486-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97268207RC0200X, 207RP1001X
CAA102461207RC0200X, 207RP1001X
CAA82228207RC0200X, 207RP1001X, 207RS0012X
CAA88722207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty