| Russ T Shimizu, M.d., Inc. | |
|
2811 Wilshire Blvd Ste 550 Santa Monica CA 90403-4806 | |
| (310) 829-5968 | |
| (310) 453-3685 |
| Full Name | Russ T Shimizu, M.d., Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2811 Wilshire Blvd Ste 550, Santa Monica, California |
| Authorized Official Name and Position | Russ T Shimizu (OWNER) |
| Authorized Official Contact | 3108295968 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Russ T Shimizu, M.d., Inc. 2811 Wilshire Blvd Ste 550 Santa Monica CA 90403-4806 Ph: (310) 323-0026 | Russ T Shimizu, M.d., Inc. 2811 Wilshire Blvd Ste 550 Santa Monica CA 90403-4806 Ph: (310) 829-5968 |
| NPI Number | 1912167461 |
|---|---|
| Provider Enumeration Date | 06/09/2008 |
| Last Update Date | 02/11/2021 |
| Certification Date | 02/11/2021 |
| Medicare PECOS PAC ID | 6406915883 |
|---|---|
| Medicare Enrollment ID | O20081030000687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912167461 | NPI | - | NPPES |
| C33305 | Other | CA | BLUE CROSS |
| 00C333052 | Other | CA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | C33305 (California) | Primary |
| Provider Name | Russ T Shimizu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780688242 PECOS PAC ID: 4486694742 Enrollment ID: I20081030000684 |
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