Individual
ISI RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4060 E WHITTIER BLVD, LOS ANGELES, CA 90023-2526
(323) 268-5514
Mailing address
PO BOX 11600, WESTMINSTER, CA 92685-1600
(562) 809-3541
(562) 468-0347
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
G37214
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G372140
—
CA
Enumeration date
05/02/2006
Last updated
04/14/2008
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