Provider Demographics
NPI:1710367420
Name:RUSSELL, CHRISTINE JACORIE (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:JACORIE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:JACORIE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1770 N ORANGE GROVE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3027
Mailing Address - Country:US
Mailing Address - Phone:909-469-9494
Mailing Address - Fax:
Practice Address - Street 1:835 N HIGHLAND SPRINGS AVE STE 206
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-9222
Practice Address - Country:US
Practice Address - Phone:951-572-8100
Practice Address - Fax:951-572-8114
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine