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NPI Code Detail

MEDICARE: MS. PAMELA RUSSELL

MEDICARE: MS. PAMELA RUSSELL
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1700208154
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PAMELA RUSSELL
Provider Business Mailing Address
First Line : 177 E COLORADO BLVD STE 200
Second Line :
City : PASADENA
State : CA
Zip : 91105-1955
Country : US
Telephone Number : 844-669-7827
Fax Number :
Provider Business Practice Location Address
First Line : 177 E COLORADO BLVD STE 200
Second Line :
City : PASADENA
State : CA
Zip : 91105-1955
Country : US
Telephone Number : 844-669-7827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2014
Last Update Date : 07/30/2021

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Directions to “ MS. PAMELA RUSSELL ” Practice Location

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