Russo, Michael Anthony

Russo, Michael Anthony is an individual health care provider with primary practice located at 1811 Brookfurst St #5600 , Fountain Valley CA 92708-6728. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Russo, Michael Anthony can be contacted via phone (714) 861-4666.

Contact Information

Primary practice address
1811 Brookfurst St #5600 Fountain Valley CA 92708-6728
Phone: (714) 861-4666
Fax: (714) 861-4682
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X Q1013 Texas
Allopathic & Osteopathic Physicians / Surgery 208600000X A125016 California

Profile Details

NPI number 1700084381
LBN Legal business name Russo, Michael Anthony
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2007
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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700084381 NPPES
Nevada Other ASO2532199374 NV BOARD OF PHARM
Nevada Other LL1802 NV BOARD OF PHARM

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