Individual
RYAN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2376 SOTO ST, SAN DIEGO, CA 92107-1410
(414) 803-6018
Mailing address
2376 SOTO ST, SAN DIEGO, CA 92107-1410
(414) 803-6018
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
4605
CA
Other
Enumeration date
11/07/2020
Last updated
11/07/2020
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