Individual
MR. RUSSELL ANDRADA DELA ROSA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
C.O.
Contact information
Practice address
4860 Y ST, SUITE 1131, SACRAMENTO, CA 95817-2307
(916) 734-6732
(916) 734-6734
Mailing address
3235 SANTA CRUZ RD, WEST SACRAMENTO, CA 95691-5857
(916) 371-8287
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO# 2773
CERTIFIED ORTHOTIST
—
Enumeration date
12/09/2005
Last updated
07/08/2007
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