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Organization
MED-1 MEDICAL CENTER PROFESSIONAL CORPORATION
Active
Organization
MED-1 MEDICAL CENTER PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN RUSSAKOV M.D (PRESIDENT)
(290) 574-1355
Entity
Organization
Contact information
Practice address
3508 DALE RD, MODESTO, CA 95356-0552
(209) 574-1355
(209) 571-8204
Mailing address
3508 DALE RD, MODESTO, CA 95356-0552
(209) 574-1355
(209) 571-8204
Taxonomy
Speciality
Code
Description
License number
State
261QC1800X
Corporate Health Clinic/Center
Primary
G75606
CA
Other
Enumeration date
12/04/2006
Last updated
08/22/2020
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