Individual
RUSSELL E. NILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3000 Q ST, SACRAMENTO, CA 95816-7058
(916) 733-5336
(916) 733-5385
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
G32453
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000810354304
PHCS
CA
05
—
00G324530
—
CA
01
—
012413
HEALTH NET
CA
01
—
1211321
GREAT WEST
CA
01
—
14028
INTERPLAN
CA
01
—
216368
UNITED HEALTHCARE
CA
01
—
4054751
AETNA
CA
01
—
4364920
CIGNA
CA
01
—
4812
FIRST HEALTH
CA
01
—
90018849
PACIFICARE
CA
01
—
G62453
BLUE CROSS
CA
01
—
MCMG170800
WESTERN HEALTH ADVANTAGE
CA
Enumeration date
07/28/2006
Last updated
02/10/2012
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