MEDICARE: AMANDA LARUSSA

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1568313971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LARUSSA

Provider Business Mailing Address
First Line	:	3570 CAMINO DEL RIO N STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1747
Country	:	US
Telephone Number	:	619-507-9333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 CAMINO DEL RIO N STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1747
Country	:	US
Telephone Number	:	619-507-9333
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/06/2026

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Directions to “ AMANDA LARUSSA ” Practice Location

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