Individual
MR. TERENCE P RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
550 WATER ST STE A, SANTA CRUZ, CA 95060-4126
(831) 462-8260
(831) 462-8262
Mailing address
550 WATER ST STE A, SANTA CRUZ, CA 95060-4126
(831) 462-8260
(831) 462-8262
Taxonomy
Speciality
Code
Description
License number
State
231HA2500X
Assistive Technology Supplier Audiologist
Primary
AU610
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AU610
CALIFORNIA AUDIOLOGY LICE
CA
01
—
HA1037
HEARING AID DISPENSER
CA
Enumeration date
02/01/2007
Last updated
01/25/2018
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