Individual
BIANCA ELIZABETH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 MEDICAL PLAZA STE 256, LOS ANGELES, CA 90095
(310) 206-6581
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
A154948
CA
208000000X
Pediatrics Physician
A154948
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2013
Last updated
07/06/2023
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