Healthcare Provider Details

I. General information

NPI: 1952556292
Provider Name (Legal Business Name): RUSSELL FRANCIS IIAMS JR. P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S ANITA DR STE 201
ORANGE CA
92868-3346
US

IV. Provider business mailing address

13472 GILBERT ST.
GARDEN GROVE CA
92844
US

V. Phone/Fax

Practice location:
  • Phone: 714-410-3505
  • Fax:
Mailing address:
  • Phone: 949-463-9441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number29029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: