Marco Russo

Primary specialty

Gerontology Occupational TherapistTaxonomy code 225XG0600X

License

11963 Issued in CA

Practice address

3841 Brickway Blvd
Santa Rosa, CA 95403-8226

Phone

(707) 524-6876

NPI assigned

Oct 14, 2026

Last updated

Oct 14, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1791936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791936000000",
    "number": "1649176983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3525 ROUND BARN BLVD UNIT 3302",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3841 BRICKWAY BLVD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038226",
            "telephone_number": "707-524-6876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "MARCO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-10-14",
        "last_updated": "2026-10-14",
        "certification_date": "2026-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "CA",
            "license": "11963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "N/A",
            "affiliation": "Y",
            "affiliationName": "Veterans Administration",
            "address_1": "3841 Brickway Blvd",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954038226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brandon Timothy Russell
• Celena Russell
• Honora Russell, MS OTL
• Juanita Gwendolyn Russell, MFT
• Kevin Russell, M.F.T.
• Janet Ann Rustigan, LMFT
• Edward Rutherford
• Joseph David Rutkowski, DMD
• Jessica Anne Rutland, R.D.
• Ashley Rutledge

• Gerontology Occupational Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Gerontology Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2026; 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.