Individual
DR. CHRISTY A RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1441 EASTLAKE AVE, NOR 8302E, LOS ANGELES, CA 90089-0112
(323) 865-3105
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 865-3105
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
G49893
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G498930
BLUE SHIELD
CA
05
—
00G498930
—
CA
01
—
1356390009
GROUP NPI
CA
01
—
1902846306
GROUP NPI
CA
01
—
900002283
RAILROAD MEDICARE
CA
01
—
CE1617
GROUP RAILROAD MEDICARE
CA
01
—
GR0016910
GROUP MEDICAID PIN
CA
01
—
GR0100430
GROUP MEDICAL
CA
01
—
W11675
GROUP MEDICARE PIN
CA
01
—
W18762
GROUP MEDICARE
CA
Enumeration date
06/30/2006
Last updated
09/03/2014
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