Provider Demographics
NPI:1881810455
Name:RUSSELL, BYRON JAMES (LAC)
Entity type:Individual
Prefix:MR
First Name:BYRON
Middle Name:JAMES
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1913
Mailing Address - Country:US
Mailing Address - Phone:415-902-4070
Mailing Address - Fax:
Practice Address - Street 1:2211 POST ST STE 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3467
Practice Address - Country:US
Practice Address - Phone:415-902-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist