Healthcare Provider Details

I. General information

NPI: 1174688956
Provider Name (Legal Business Name): CYNTHIA ELLEN RUSSELL-MCCLAIN N.P., P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UPPER RAGSDALE DR SUITE 200
MONTEREY CA
93940-7849
US

IV. Provider business mailing address

17621 CUNHA LN
SALINAS CA
93907-1528
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-3577
  • Fax: 831-375-1478
Mailing address:
  • Phone: 831-754-1544
  • Fax: 831-754-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberPA14098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: