Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | IMF53 | CA |
NPI | 1003019068 |
---|---|
Provider Name | Russell Shuben |
First Address | North Hollywood, CA 91605-5162 |
Second Address | North Hollywood, CA 91605-5162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 08/07/2007 |