| Doctor Name: | WESLEY ALEXANDER RUSSELL |
| NPI Number: | 1568580298 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BA |
| License Number: | |
| Business Practice Address: | 2010 E El Segundo Blvd Compton, CA - 902227109 |
| Business Phone Number: | 3106370917 |
| Business Fax Number: | 3106370473 |
| Mailing Address: | 11245 S Budlong Ave, LOS ANGELES |
| State: | CA |
| Postal Code: | 900441309 |
| Phone Number: | 3237559694 |
| Fax Number: | 3237559694 |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Rehabilitation Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |