Provider Demographics
NPI:1427533256
Name:POWER, RUSSELL
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:POWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12024 WINTERCREST DR APT 1
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-3747
Mailing Address - Country:US
Mailing Address - Phone:619-334-8316
Mailing Address - Fax:
Practice Address - Street 1:2260 WATSON WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7924
Practice Address - Country:US
Practice Address - Phone:760-599-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)