MEDICARE: MARINA RUSSMAN M.D., APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		CA

General Provider Information

NPI Number	:	1053862029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINA RUSSMAN M.D., APC

Provider Business Mailing Address
First Line	:	8306 WILSHIRE BLVD # 1808
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2304
Country	:	US
Telephone Number	:	310-273-2707
Fax Number	:	310-273-2737

Provider Business Practice Location Address
First Line	:	250 N ROBERTSON BLVD STE 106
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1767
Country	:	US
Telephone Number	:	310-273-2707
Fax Number	:	310-273-2737

Authorized Official
Title or Position	:	OWNER
Name	:	F MARINA RUSSMAN
Credential	:	M.D.
Telephone Number	:	310-273-2707

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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