Healthcare Provider Details

I. General information

NPI: 1619988532
Provider Name (Legal Business Name): JOIE RUSSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18034 VENTURA BLVD STE 332
ENCINO CA
91316-3516
US

IV. Provider business mailing address

18034 VENTURA BLVD STE 332
ENCINO CA
91316-3516
US

V. Phone/Fax

Practice location:
  • Phone: 818-757-2345
  • Fax: 818-757-0137
Mailing address:
  • Phone: 818-757-2345
  • Fax: 818-757-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number20A8335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: