Provider Demographics
NPI:1104954072
Name:DRS. MUSCO INC.
Entity type:Organization
Organization Name:DRS. MUSCO INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETERY
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLROES
Authorized Official - Middle Name:KATARZYNA
Authorized Official - Last Name:MUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-866-1005
Mailing Address - Street 1:2301 CAMINO RAMON
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4440
Mailing Address - Country:US
Mailing Address - Phone:925-866-1005
Mailing Address - Fax:925-866-1006
Practice Address - Street 1:2301 CAMINO RAMON
Practice Address - Street 2:SUITE 180
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4440
Practice Address - Country:US
Practice Address - Phone:925-866-1005
Practice Address - Fax:925-866-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64340ZOtherBLUE CROSS BLUE SHIELD
CAGROO99710Medicaid
CAZZZ31687ZMedicare ID - Type Unspecified