Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 141218 | CA |
NPI | 1194045450 |
---|---|
Provider Name | Russell Odono |
First Address | Lancaster, CA 93534-7211 |
Second Address | Lancaster, CA 93534-7211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2010 |
Last Update Date | 06/12/2021 |