Individual
JAQUEESE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
390 40TH ST, OAKLAND, CA 94609-2633
(510) 899-0128
(510) 569-4589
Mailing address
390 40TH ST, OAKLAND, CA 94609-2633
(510) 899-0128
(510) 569-4589
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
05/20/2024
Last updated
06/27/2024
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