Individual
RUSSELL JAY NILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1011 CAMINO DEL RIO SOUTH, SUITE 300, SAN DIEGO, CA 92108
(619) 287-8225
(619) 393-0386
Mailing address
1011 CAMINO DEL RIO SOUTH, SUITE 300, SAN DIEGO, CA 92108
(619) 287-8225
(619) 393-0386
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-WMGELR
CA
225400000X
Rehabilitation Practitioner
—
CA
Other
Enumeration date
04/01/2026
Last updated
04/02/2026
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