Healthcare Provider Details

I. General information

NPI: 1174857213
Provider Name (Legal Business Name): VICTOR RUSENESCU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 WESTCLIFF DR STE 203
NEWPORT BEACH CA
92660-5512
US

IV. Provider business mailing address

2135 WESTCLIFF DR STE 203
NEWPORT BEACH CA
92660-5512
US

V. Phone/Fax

Practice location:
  • Phone: 949-379-8400
  • Fax: 949-264-2811
Mailing address:
  • Phone: 714-256-5074
  • Fax: 714-256-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: