Basic Information
| Provider Information | |||||||||
| NPI: | 1497833883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSU | ||||||||
| FirstName: | DAN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 990208 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960990208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365529113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2175 ROSALINE AVE | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960012509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302411473 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A100840 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A100840 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 25MA08143200 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A100840 | 01 | CA | CA MED LICENSE | OTHER |