Individual
MR. RUSSELL FRANCIS IIAMS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
14411 VANOWEN ST, VAN NUYS, CA 91405-4038
(818) 989-7475
Mailing address
4367 VIA LARGO, CYPRESS, CA 90630-3451
(714) 471-6720
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
29029
CA
Other
Enumeration date
12/01/2008
Last updated
12/01/2008
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