Basic Information
| Provider Information | |||||||||
| NPI: | 1104949957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSS | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77441 EVENING STAR CIR | ||||||||
| Address2: | |||||||||
| City: | INDIAN WELLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922107597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604698177 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 42382 BOB HOPE DR. | ||||||||
| Address2: | |||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603419619 | ||||||||
| FaxNumber: | 7607765861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA4053 | CA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.