Provider Demographics
NPI:1710661897
Name:CANNELL, RUSLANA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:RUSLANA
Middle Name:MARIA
Last Name:CANNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 LESSIE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-1232
Mailing Address - Country:US
Mailing Address - Phone:949-491-3423
Mailing Address - Fax:
Practice Address - Street 1:14375 NASON ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4729
Practice Address - Country:US
Practice Address - Phone:951-486-5907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program