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Organization
LOS MEDANOS MEDICAL GROUP, INC.
Active
Organization
LOS MEDANOS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RUSSELL M.D. (PRESIDENT)
(925) 432-2977
Entity
Organization
Contact information
Practice address
3006 RAILROAD AVE, PITTSBURG, CA 94565-5202
(925) 432-2977
(925) 432-6418
Mailing address
3006 RAILROAD AVE, PITTSBURG, CA 94565-5202
(925) 432-2977
(925) 432-6418
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G30873
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ71706Z
—
CA
Enumeration date
12/14/2006
Last updated
08/22/2020
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