Individual
BRYAN CLINT RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
160 C AVE, CORONADO, CA 92118-1420
(619) 319-5992
Mailing address
6621 ARCHWOOD AVE, SAN DIEGO, CA 92120-2401
(619) 319-5992
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT295117
CA
Other
Enumeration date
01/15/2019
Last updated
01/15/2019
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