Individual
MR. RUSSELL LAROY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11629 SUENO CT., FONTANA, CA 92337
(323) 801-9208
Mailing address
11629 SUENO CT., FONTANA, CA 92337
(323) 801-9208
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/12/2014
Last updated
05/12/2014
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