Individual
MISS KEASHA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
3401 MUSTANG WAY, HEMET, CA 92545-9257
(951) 760-1600
Mailing address
12648 MEMORIAL WAY, 2075, MORENO VALLEY, CA 92553-7553
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000003064
CA
Other
Enumeration date
01/26/2015
Last updated
01/26/2015
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