Facey Medical Group a Medical Corporation

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

FACEY MEDICAL GROUP A MEDICAL CORPORATION

Practice address

15451 San Fernando Mission Blvd
Suite 200
Mission Hills, CA 91345-1368

Phone

(818) 837-5785

NPI assigned

Jan 23, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fredrick Russo, MD

Title

President

Phone

(818) 837-5785

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1013255280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15451 SAN FERNANDO MISSION BLVD",
            "address_2": "SUITE 200",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913451368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15451 SAN FERNANDO MISSION BLVD",
            "address_2": "SUITE 200",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913451368",
            "telephone_number": "818-837-5785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACEY MEDICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-23",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "FREDRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-837-5785",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.