Individual
SANDRA GERALDINE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2925 PALO VERDE AVE, LONG BEACH, CA 90815-1552
(562) 429-2473
(562) 496-5577
Mailing address
2925 PALO VERDE AVE, LONG BEACH, CA 90815-1552
(562) 429-2473
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
838417
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8381417
CDR
CA
Enumeration date
06/18/2007
Last updated
08/26/2008
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