Healthcare Provider Details

I. General information

NPI: 1437013901
Provider Name (Legal Business Name): AMBER RUSSELL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 IMPERIAL HWY STE B
DOWNEY CA
90242-3457
US

IV. Provider business mailing address

7840 IMPERIAL HWY STE B
DOWNEY CA
90242-3457
US

V. Phone/Fax

Practice location:
  • Phone: 562-822-3818
  • Fax:
Mailing address:
  • Phone: 213-784-7918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: