Individual
DR. MARK RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13024 HESPERIA RD STE 103, VICTORVILLE, CA 92395-8303
(760) 241-3547
(760) 241-3562
Mailing address
12223 HIGHLAND AVE # 106-536, RANCHO CUCAMONGA, CA 91739-2574
(760) 241-3547
(760) 241-3562
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
229134
NY
207RC0000X
Cardiovascular Disease Physician
A144701
CA
207RI0011X
Interventional Cardiology Physician
Primary
A144701
CA
390200000X
Student in an Organized Health Care Education/Training Program
229134
NY
Other
Enumeration date
05/02/2006
Last updated
07/08/2020
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