Individual
MR. ANDREW WRAY RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
124 E OLIVE AVE, REDLANDS, CA 92373-5250
(909) 798-9403
Mailing address
223 BELMONT CT, REDLANDS, CA 92373-7118
(909) 644-6420
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
01024357
CA
363AM0700X
Medical Physician Assistant
Primary
PA53942
CA
Other
Enumeration date
12/15/2016
Last updated
12/15/2016
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