Provider Demographics
NPI:1992331094
Name:LIBRADO, RUSSFIR
Entity type:Individual
Prefix:
First Name:RUSSFIR
Middle Name:
Last Name:LIBRADO
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 1:1813 TEALWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0638
Mailing Address - Country:US
Mailing Address - Phone:757-553-6659
Mailing Address - Fax:
Practice Address - Street 1:1813 TEALWOOD LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0638
Practice Address - Country:US
Practice Address - Phone:757-553-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program