Individual
MISS CELENA MARIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 355-1122
Mailing address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060300150851609
DRIVER'S LICENSE
VA
Enumeration date
08/08/2022
Last updated
04/07/2026
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