Individual
CLAIRE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4080 CENTRE ST, SAN DIEGO, CA 92103-2655
(619) 922-9933
Mailing address
4080 CENTRE ST, SAN DIEGO, CA 92103-2655
(619) 922-9933
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L 9532
CA
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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