Individual
BENJAMIN BRUNDAGE RUSSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1450 MAIN ST, WEAVERVILLE, CA 96093-1099
(530) 623-1362
Mailing address
PO BOX 1450, WEAVERVILLE, CA 96093-1450
(530) 623-1362
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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