Individual
DR. NICHOLAS RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2967 N MOORPARK RD, THOUSAND OAKS, CA 91360-4573
(805) 492-2436
Mailing address
2967 N MOORPARK RD, THOUSAND OAKS, CA 91360-4573
(805) 492-2436
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
17490
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17490
DVM LICENSE
CA
Enumeration date
07/10/2019
Last updated
07/10/2019
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