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Organization
THE BOTOX SPOT PHYSICIAN ASSISTANT CORPORATION
Active
Organization
THE BOTOX SPOT PHYSICIAN ASSISTANT CORPORATION
Active
Other names
The Botox Spot, The Botox Spot Physician Assistant Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW RUSS PA-C (OWNER)
(909) 752-6869
Entity
Organization
Contact information
Practice address
914 ORANGE ST STE E, REDLANDS, CA 92374-3281
(909) 752-6869
Mailing address
1083 RAVEN CT, CALIMESA, CA 92320-4921
(909) 752-6869
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
12/25/2023
Last updated
12/25/2023
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