Active NPI
Angela Marie Russo, BCBA
- Behavior Analyst
- Pomona, CA
National Provider Identifier
1053841858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-16-24693
- Practice address
- 801 Corporate Center Dr Ste 210
Pomona, CA 91768-2627 - Phone
- (909) 618-0974
- NPI assigned
- Jun 14, 2017
- Last updated
- Jun 20, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-16-24693 | CA | Primary |
Addresses
Primary practice location
801 Corporate Center Dr Ste 210
Pomona, CA 91768-2627
Mailing address
10442 Yolanda Ave
Porter Ranch, CA 91326-3440
Phone (818) 606-3754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Pediatric Behavioral Health LLC | Behavior Analyst | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Porter Ranch, CA
- NPI 1831748581
Behavior Analyst
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497916800000",
"number": "1053841858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10442 YOLANDA AVE",
"city": "PORTER RANCH",
"state": "CA",
"postal_code": "913263440",
"telephone_number": "818-606-3754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 CORPORATE CENTER DR STE 210",
"city": "POMONA",
"state": "CA",
"postal_code": "917682627",
"telephone_number": "909-618-0974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "ANGELA",
"middle_name": "MARIE",
"credential": "BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-14",
"last_updated": "2017-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-16-24693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.