Individual
RUSSELL KENJI TAMASHIRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3861 MONTGOMERY DR, SANTA ROSA, CA 95405-5244
(707) 666-5863
Mailing address
3861 MONTGOMERY DR, SANTA ROSA, CA 95405-5244
(707) 666-5863
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
83366
CA
Other
Enumeration date
04/02/2022
Last updated
08/31/2022
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