Individual
ANGELA MARIE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
801 CORPORATE CENTER DR STE 210, POMONA, CA 91768-2627
(909) 618-0974
Mailing address
10442 YOLANDA AVE, PORTER RANCH, CA 91326-3440
(818) 606-3754
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-24693
CA
Other
Enumeration date
06/14/2017
Last updated
06/20/2017
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