Organization
FACEY MEDICAL GROUP A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREDRICK RUSSO MD (PRESIDENT)
(818) 837-5785
Entity
Organization
Contact information
Practice address
15451 SAN FERNANDO MISSION BLVD, SUITE 200, MISSION HILLS, CA 91345-1368
(818) 837-5785
Mailing address
15451 SAN FERNANDO MISSION BLVD, SUITE 200, MISSION HILLS, CA 91345-1368
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Enumeration date
01/23/2013
Last updated
01/23/2013
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