Individual
RUBY LORETTA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18700 N 64TH DR STE 301, GLENDALE, AZ 85308-7114
(602) 841-0741
Mailing address
18700 N 64TH DR STE 301, GLENDALE, AZ 85308-7114
(602) 841-0741
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
CA
Other
Enumeration date
09/18/2017
Last updated
07/13/2024
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