Healthcare Provider Details

I. General information

NPI: 1417274200
Provider Name (Legal Business Name): JOSHUA RUSSELL M.D., MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N SEPULVEDA BLVD
MANHATTAN BEACH CA
90266-2453
US

IV. Provider business mailing address

3215 N SEPULVEDA BLVD
MANHATTAN BEACH CA
90266-2453
US

V. Phone/Fax

Practice location:
  • Phone: 424-295-0540
  • Fax:
Mailing address:
  • Phone: 424-295-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA151987
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD154397
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60339182
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPG152145
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberMD60339182
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberMD154397
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: