MEDICARE: DR. JOSHUA RUSSELL M.D., MSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD154397	OR
2	261QU0200X	Urgent Care Clinic/Center	A151987	CA
3	207P00000X	Emergency Medicine Physician	MD60339182	WA
4	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	MD60339182	WA
5	207Q00000X	Family Medicine Physician	PG152145	OR
6	390200000X	Student in an Organized Health Care Education/Training Program
7	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	MD154397	OR

General Provider Information

NPI Number	:	1417274200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA RUSSELL M.D., MSC

Provider Business Mailing Address
First Line	:	3215 N SEPULVEDA BLVD
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2453
Country	:	US
Telephone Number	:	424-295-0540
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 N SEPULVEDA BLVD
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2453
Country	:	US
Telephone Number	:	424-295-0540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	02/23/2026

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