MEDICARE: RUSLANA MARIA CANNELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	201695	CA

General Provider Information

NPI Number	:	1710661897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSLANA MARIA CANNELL MD

Provider Business Mailing Address
First Line	:	9990 COUNTY FARM RD STE 5
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-3542
Country	:	US
Telephone Number	:	951-358-3509
Fax Number	:

Provider Business Practice Location Address
First Line	:	9990 COUNTY FARM RD STE 5
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-3542
Country	:	US
Telephone Number	:	951-358-3509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2023
Last Update Date	:	12/05/2025

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