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Individual

BOHDAN RUSSUM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
500 CROWN POINT CIR, GRASS VALLEY, CA 95945-9561
(415) 847-8420
Mailing address
10560 KEARNEY CT, SMARTSVILLE, CA 95977-9556
(415) 847-8420

Taxonomy

Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
CA

Other

Enumeration date
03/02/2026
Last updated
03/02/2026
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