Individual
CHRISTINA L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
525 OAK CENTRE DR STE 100, SAN ANTONIO, TX 78258-3916
(210) 640-9048
Mailing address
525 OAK CENTRE DR, STE 140, SAN ANTONIO, TX 78258-3916
(210) 504-3650
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA13547
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T000
PHYSICIAN ASSISTANT LICENSE NUMBER
TX
Enumeration date
02/11/2020
Last updated
06/25/2020
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