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Individual

DIANA MARIE RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
H.H.P

Contact information

Practice address
7773 UNIVERSITY AVE, LA MESA, CA 91942-4950
(619) 303-5702
(619) 825-8742
Mailing address
7773 UNIVERSITY AVE, LA MESA, CA 91942-4950
(619) 303-5702
(619) 825-8742

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
385759-00
CA
364SH1100X
Holistic Clinical Nurse Specialist
Primary
385759-00
CA

Other

Enumeration date
03/10/2010
Last updated
03/10/2010
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