Theresa Joanne Russell CADC-11

NPI 1255465530 - Specialist - 174400000X

NPI Details
NPI 1255465530
Gender Female
Enumeration Date 03/16/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
5494 PONY EXPRESS TRAIL
POLLOCK PINES CA, 95726, US
Phone (530) 664-3758
Fax (530) 644-3782
Business Location
2173 DANBURY WAY
RANCHO CORDOVA CA, 95670-2271, US
Phone (916) 635-6791
Fax
Toxanomy
Taxonomy Code 174400000X
License State California
License Number A8463203
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According to our database, Ms. Theresa Joanne Russell CADC-11 NPI is 1255465530, taxonomy code is 174400000X and license number is A8463203, license state is located at California. Theresa Joanne Russell CADC-11 physically located at 5494 Pony Express Trail, Pollock Pines CA, 95726. NPI Number Theresa Joanne Russell CADC-11 has the Individual type.

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1255465530 NPI number is provided on an as is basis without warranty of any kind. 1255465530 is maintained by the National Plan & Provider Enumeration System. The contents of Theresa Joanne Russell CADC-11 are for informational purposes only.