Russell, Tara Anastasia
Russell, Tara Anastasia is an individual health care provider with primary practice located at 200 Ucla Medical Plz Ste 214 , Los Angeles CA 90095-3955. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is her primary health care specialty. Russell, Tara Anastasia can be contacted via phone (310) 794-7788.Contact Information
Primary practice address
200 Ucla Medical Plz Ste 214
Los Angeles CA 90095-3955
Phone: (310) 794-7788
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Colon & Rectal Surgery | 208C00000X | A136212 | California |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | California | |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | A136212 | California |
Profile Details
| NPI number | 1982047635 |
|---|---|
| LBN Legal business name | Russell, Tara Anastasia |
| Credentials | MD, MPH |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 12th, 2013 |
| Last updated | Mar 7th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982047635 | NPPES |
| California | Other | A136212 | CALIFORNIA STATE MEDICAL LICENSE |
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