Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G64389 | CA |
NPI | 1316095128 |
---|---|
Provider Name | Steven C. Russak |
First Address | Woodland Hills, CA 91367-6701 |
Second Address | Woodland Hills, CA 91367-6701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 01/12/2021 |