Individual
DANIEL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 N STATE ST, UKIAH, CA 95482-3410
(707) 467-2010
Mailing address
PO BOX 2077, UKIAH, CA 95482-2077
(077) 467-2010
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
01/08/2020
Last updated
10/20/2023
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