Individual
MR. ANTHONY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
219 20TH AVE, SANTA CRUZ, CA 95062-4953
(650) 483-7703
Mailing address
219 20TH AVE, SANTA CRUZ, CA 95062-4953
(650) 483-7703
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G19800
CA
207RP1001X
Pulmonary Disease Physician
G19800
CA
Other
Enumeration date
05/10/2006
Last updated
12/10/2022
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