Healthcare Provider Details

I. General information

NPI: 1144654377
Provider Name (Legal Business Name): KELSEY ELIZABETH RUSZEL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 DAVID AVE STE 100
CONCORD CA
94518-3835
US

IV. Provider business mailing address

1225 DAVID AVE STE 100
CONCORD CA
94518-3835
US

V. Phone/Fax

Practice location:
  • Phone: 925-238-3307
  • Fax:
Mailing address:
  • Phone: 925-238-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-785
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: