Provider Demographics
NPI:1801104245
Name:RUSSELL, MARTA RODRIGUEZ (LVN)
Entity type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:RODRIGUEZ
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 ONEIDA PL
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-4751
Mailing Address - Country:US
Mailing Address - Phone:805-278-0778
Mailing Address - Fax:
Practice Address - Street 1:2241 LAUREL VALLEY PL
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-7714
Practice Address - Country:US
Practice Address - Phone:805-988-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185502164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse