Individual
RUSSELL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8920 HOLLY AVE NE, ALBUQUERQUE, NM 87122-2988
(505) 379-1550
Mailing address
8920 HOLLY AVE NE, ALBUQUERQUE, NM 87122-2988
(505) 379-1550
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
06/02/2014
Last updated
06/02/2014
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