Andrea Russo, OD
Optometrist in San Diego, CA. Individual provider (NPI-1).
NPI number1083190854
StatusActive
Last updated in NPPESOct 24, 2019
Details
- NPI
- 1083190854
- Entity type
- Individual (NPI-1)
- Name
- Andrea Russo
- Credential
- OD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 16, 2018
- Last updated
- Oct 24, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 34290TLG | CA | Yes |
Practice location
3350 La Jolla Village DrSan Diego, CA 92161-0002
Phone 858-552-8585
Mailing address
4353 La Jolla Village DrSan Diego, CA 92122-1259
Phone 858-622-2165
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