Provider Demographics
NPI:1649709189
Name:HUNTINGTON UROLOGY SPECIALISTS, INC.
Entity type:Organization
Organization Name:HUNTINGTON UROLOGY SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-650-3353
Mailing Address - Street 1:800 S. FAIRMOUNT AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3154
Mailing Address - Country:US
Mailing Address - Phone:626-486-0184
Mailing Address - Fax:626-486-0217
Practice Address - Street 1:800 FAIRMOUNT AVE STE 412
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3154
Practice Address - Country:US
Practice Address - Phone:626-486-0184
Practice Address - Fax:626-486-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty