Individual
SELENA ROSE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
99-115 AIEA HEIGHTS DR STE 276B, AIEA, HI 96701-3924
(808) 784-3050
(808) 486-5558
Mailing address
99-115 AIEA HEIGHTS DR STE 276B, AIEA, HI 96701-3924
(718) 249-5360
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
AMD-1004
HI
Other
Enumeration date
12/01/2017
Last updated
10/29/2024
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