Basic Information
| Provider Information | |||||||||
| NPI: | 1134133242 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZANE | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | RONALD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 MISSION AVE | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920542328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608277210 | ||||||||
| FaxNumber: | 7608277215 | ||||||||
| Practice Location | |||||||||
| Address1: | 2176 SALK AVE | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920087346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608277210 | ||||||||
| FaxNumber: | 7608277215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G77358 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G773580 | 05 | CA | MEDICAID |