Provider Demographics
NPI:1962212340
Name:RAZINN, RUSS (MANAGER)
Entity type:Individual
Prefix:
First Name:RUSS
Middle Name:
Last Name:RAZINN
Suffix:
Gender:M
Credentials:MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W PASADENA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2086
Mailing Address - Country:US
Mailing Address - Phone:602-803-9575
Mailing Address - Fax:
Practice Address - Street 1:13827 N 41ST PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5815
Practice Address - Country:US
Practice Address - Phone:602-449-8494
Practice Address - Fax:855-288-9241
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ145292171M00000X
AZ166955171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator