Individual
RYAN A RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP
Contact information
Practice address
8540 RESEDA BLVD, NORTHRIDGE, CA 91324-4628
(818) 718-4643
Mailing address
8540 RESEDA BLVD, NORTHRIDGE, CA 91324-4628
(818) 718-4643
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
10/05/2007
Last updated
10/05/2007
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