Individual
RYAN J RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1509 WILSON TER, GLENDALE, CA 91206-4007
(818) 409-8000
Mailing address
224 E DIXON ST, AZUSA, CA 91702-4907
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
783097
CA
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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