Active NPI
Russell Spadaro, M.D.
- Pediatrics Physician
- Thousand Oaks, CA
National Provider Identifier
1619948445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G55882
- Practice address
- 2125 E Thousand Oaks Blvd # B-1
Thousand Oaks, CA 91362-2942 - Phone
- (805) 493-1964
- Fax
- (805) 492-0614
- NPI assigned
- Jan 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G55882 | CA | Primary |
Addresses
Primary practice location
2125 E Thousand Oaks Blvd # B-1
Thousand Oaks, CA 91362-2942
Mailing address
2125 E Thousand Oaks Blvd # B-1
Thousand Oaks, CA 91362-2942
Phone (805) 493-1964
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G55882 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661299200000",
"number": "1619948445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2125 E THOUSAND OAKS BLVD # B-1",
"city": "THOUSAND OAKS",
"state": "CA",
"postal_code": "913622942",
"telephone_number": "805-493-1964",
"fax_number": "805-241-5382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2125 E THOUSAND OAKS BLVD # B-1",
"city": "THOUSAND OAKS",
"state": "CA",
"postal_code": "913622942",
"telephone_number": "805-493-1964",
"fax_number": "805-492-0614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPADARO",
"first_name": "RUSSELL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-30",
"last_updated": "2022-08-24",
"certification_date": "2022-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G55882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Thousand Oaks, CA
- Southern California Anesthesia & Pain Management, Inc
- Southern California Orthopedic Institute, LP
- Southern California Orthopedic Institute, LP
- Southern California Pulmonary and Sleep Disorders Medical Center Inc.
- Spadaro & Weisz a Medical Corporation
- Erik C Spayde, MD
- David Lynn Speakman, D.C.
- Spears Babcock DO PC
- Speciality Hospitalist Inc
- Specialty Care Pharmacy, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.