Individual
JASON RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
95 S SANTA ROSA ST, VENTURA, CA 93001-3442
(805) 205-4787
Mailing address
95 S SANTA ROSA ST, VENTURA, CA 93001-3442
(805) 205-4787
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
226922
CA
Other
Enumeration date
01/07/2010
Last updated
01/07/2010
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