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General NPI Number Information
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NPI Number | 1346256369
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Entity Type | Individual
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Provider Name | RUSSELL E. CONSIGLIO P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3160 FOLSOM BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95816-5219
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Country | US
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Telephone | 916-733-5336
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Fax | 916-733-5385
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Provider Business Mailing Address
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Address Line | 2914 58TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95817-1741
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | PA10894
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License Number State | CA
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