MR. JEFFREY RUSSELL II (NPI# 1942858055) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942858055 |
| Entity Type | Individual |
| Full Name | MR. JEFFREY RUSSELL II |
| Credential | RADT |
| Practice Address |
1003 S Beacon St San Pedro CA 90731-4324 |
| Practice Telephone | 3105144940 |
| Mailing Telephone | 3105144940 |
| Enumeration Date | 2019-09-01 |
| Last Update Date | 2019-09-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912072257 | Jeffrey Alan Russell | Specialist/Technologist | Shape Clinic, Putnam Hall 304, 96 E Union St, Athens, OH 45701 | 2006-11-22 |
| 1942309034 | Jeffrey Lynn Russell | Podiatrist | Rr 1 Box 34-a, Watonga, OK 73772-9706 | 2006-09-22 |
| 1497799654 | Jeffrey S Russell | Internal Medicine | 327 W Chicago St, Coldwater, MI 49036-2805 | 2006-06-16 |
| 1518394204 | Jeffrey Dane Russell | Physician Assistant | 900 Caton Ave, Baltimore, MD 21229-5201 | 2013-09-26 |
| 1609193432 | Jeffrey Russell | Counselor | 201 W Springdale Ave, Knoxville, TN 37917-5158 | 2010-05-04 |
| 1073842175 | Jeffrey C. Russell | Nurse Anesthetist, Certified Registered | 9601 Interstate 630 Exit 7, Little Rock, AR 72205-7202 | 2009-12-18 |
| 1043332497 | Jeffrey Wyan Russell | Physician Assistant | 2741 Debarr Rd, Suite C-308, Anchorage, AK 99508-2953 | 2007-04-05 |
| 1578603494 | Jeffrey David Russell | Chiropractor | 302 N Mckinley Ave, Sand Springs, OK 74063-7611 | 2007-02-08 |
| 1295897130 | Jeffrey Kent Russell | Internal Medicine | 750 Alliance Ct, Asheville, NC 28806-2248 | 2006-12-15 |
| 1154482388 | Jeffrey Scott Russell | Counselor | 333 Union St, New Bedford, MA 02740-3665 | 2006-12-12 |
| Street Address |
1003 S BEACON ST |
| City | SAN PEDRO |
| State | CA |
| Zip Code | 90731-4324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265955942 | Ryan Michael Smith | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2017-07-25 |
| 1215534185 | Dandre Jones | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2020-10-05 |
| 1104432871 | Kyle Vincent Conneally | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2020-09-18 |
| 1578197216 | Gage Zachary Lindsay | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2020-03-02 |
| 1811535701 | Daniel John Carr | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2019-12-11 |
| 1447895628 | Cleveland Malcolm Brooks | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2019-11-12 |
| 1740831551 | Jakob Renato Perkov | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2019-09-23 |
| 1760030878 | Carlos Alfredo Cuevas | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2019-09-01 |
| 1285107979 | Dylan Grace | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2019-01-06 |
| 1285107946 | Jonathan Higgins | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2019-01-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962009464 | Jyoti Patel | Optometrist | 1701 Gaffey St., San Pedro, CA 90731 | 2020-10-07 |
| 1518513183 | Churairat Maffei | Technician | 1305 S Patton Ave, San Pedro, CA 90731 | 2019-08-09 |
| 1326692898 | Lori Marie Kroeker | Counselor | 235 W. 9th St, San Pedro, CA 90731 | 2019-08-01 |
| 1366960783 | Maria Elena Newcomer Dds Inc | Dentist | 847 W. 9th St., San Pedro, CA 90731 | 2017-09-06 |
| 1255875944 | Raymond J Mazuchowski Jr. | Dentist | 697 S Gaffery St, San Pedro, CA 90731 | 2016-12-14 |
| 1700235108 | Redina J Williams | Counselor | 559 W, 9th Street, San Pedro, CA 90731 | 2016-06-07 |
| 1649697764 | Leilani M. Sharpe | Psychiatry & Neurology | 222 W 6th St Ste 400, San Pedro, CA 90731 | 2014-03-26 |
| 1134418882 | Neema Rukiya Hardeman | Pediatrics | 2400 S Pacific Ave Bldg 30, San Pedro, CA 90731 | 2011-04-04 |
| 1477878148 | Karla Vanesa Cehua | Dental Assistant | 423n. Meyler St., San Pedro, CA 90731 | 2010-04-06 |
| 1023258183 | Deborah Anne Allsup | Acupuncturist | 732 W. 9th Street, #202, San Pedro, CA 90731 | 2009-03-03 |
| Find all providers in zip 90731 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073140158 | Elizabeth Ortiz Mcghee | Counselor | 505 N Pacific Ave, San Pedro, CA 90731-2021 | 2020-03-26 |
| 1164071650 | Jeffrey Andersen | Counselor | 270 W 14th St # 27, San Pedro, CA 90731-4396 | 2019-09-06 |
| 1326692898 | Lori Marie Kroeker | Counselor | 235 W. 9th St, San Pedro, CA 90731 | 2019-08-01 |
| 1598278517 | Christina Marie Ramirez | Counselor | 936 S Centre St, San Pedro, CA 90731-3737 | 2017-11-13 |
| 1265955942 | Ryan Michael Smith | Counselor | 1003 S Beacon St, San Pedro, CA 90731-4324 | 2017-07-25 |
| 1255782983 | Myrra Alo | Counselor | 235 W 9th St, San Pedro, CA 90731-3711 | 2016-06-23 |
| 1700235108 | Redina J Williams | Counselor | 559 W, 9th Street, San Pedro, CA 90731 | 2016-06-07 |
| 1700281128 | Monica Reynoso | Counselor | 222 S Cabrillo Ave Apt 106, San Pedro, CA 90731-2453 | 2014-10-28 |
| 1811331259 | Shirley Elaine Robinson | Counselor | 972 W 24th St, #5, San Pedro, CA 90731-5759 | 2013-04-27 |
| 1245545441 | Paul Miller | Counselor | 565 W 15th St, San Pedro, CA 90731-4786 | 2010-08-11 |
| Find all providers in SAN PEDRO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.