Individual
JACQUELYN CAROLE RUSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
3600 TELEGRAPH AVE, OAKLAND, CA 94609-2427
(510) 383-5161
Mailing address
330 1ST ST, SAN RAFAEL, CA 94901-3716
(510) 710-3431
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
600544
CA
Other
Enumeration date
08/20/2025
Last updated
08/20/2025
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