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General NPI Number Information
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NPI Number | 1710367420
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Entity Type | Individual
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Provider Name | CHRISTINE JACORIE RUSSELL M.D., M.B.A.
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 835 N HIGHLAND SPRINGS AVE STE 206
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City | BEAUMONT
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State | CA
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Zip | 92223-9222
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Country | US
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Telephone | 951-572-8100
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Fax | 951-572-8114
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Provider Business Mailing Address
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Address Line | 1770 N ORANGE GROVE AVE STE 101
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City | POMONA
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State | CA
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Zip | 91767-3027
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Country | US
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Telephone | 909-469-9494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 000000
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License Number State | CA
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