Provider Demographics
NPI:1992503072
Name:WEBB, RUSSEL
Entity type:Individual
Prefix:
First Name:RUSSEL
Middle Name:
Last Name:WEBB
Suffix:
Gender:
Credentials:
Other - Prefix:MISS
Other - First Name:BAMBI
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12070 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3771
Mailing Address - Country:US
Mailing Address - Phone:562-777-7500
Mailing Address - Fax:
Practice Address - Street 1:426 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2119
Practice Address - Country:US
Practice Address - Phone:213-626-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist