Provider Demographics
NPI:1063682698
Name:RUSSELL, KAREEM (CST/CSFA)
Entity Type:Individual
Prefix:
First Name:KAREEM
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 SILHOUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-1770
Mailing Address - Country:US
Mailing Address - Phone:702-336-9313
Mailing Address - Fax:702-407-0571
Practice Address - Street 1:2800 E DESERT INN RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3609
Practice Address - Country:US
Practice Address - Phone:702-294-7402
Practice Address - Fax:702-735-7966
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV87842246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist