Provider Demographics
NPI:1619263266
Name:RUSSO, FLECK & ASSOCIATES
Entity Type:Organization
Organization Name:RUSSO, FLECK & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OTR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-836-7886
Mailing Address - Street 1:960 W TOWN AND COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4714
Mailing Address - Country:US
Mailing Address - Phone:714-836-7886
Mailing Address - Fax:714-836-1109
Practice Address - Street 1:960 W TOWN AND COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4714
Practice Address - Country:US
Practice Address - Phone:714-836-7886
Practice Address - Fax:714-836-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 3204261QD1600X
CAPT 11241261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities