# MED-1 MEDICAL CENTER PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275691339
- **Authorized official:** DR. ALAN RUSSAKOV M.D (PRESIDENT)
- **Authorized official phone:** (290) 574-1355

## Contact information

- **Practice address:** 3508 DALE RD, MODESTO, CA 95356-0552
- **Practice address phone:** (209) 574-1355
- **Practice address fax:** (209) 571-8204
- **Mailing address:** 3508 DALE RD, MODESTO, CA 95356-0552
- **Mailing address phone:** (209) 574-1355
- **Mailing address fax:** (209) 571-8204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1800X | Corporate Health Clinic/Center | G75606 | CA | Yes |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 08/22/2020