The Botox Spot Physician Assistant Corporation

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

THE BOTOX SPOT PHYSICIAN ASSISTANT CORPORATION

Doing business as

The Botox Spot
The Botox Spot Physician Assistant Corporation

Practice address

914 Orange St Ste E
Redlands, CA 92374-3281

Phone

(909) 752-6869

NPI assigned

Dec 25, 2023

Last updated

Dec 25, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrew Russ, PA-CNPI 1457895054

Title

Owner

Phone

(909) 752-6869

Specialties & licenses 1

Addresses

Other names 2

• The Botox Spot Doing business as
• The Botox Spot Physician Assistant Corporation Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew Wray Russ, PA-C

  • Medical Physician Assistant
  • Redlands, CA
  • NPI 1457895054
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703462400000",
    "number": "1710756390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1083 RAVEN CT",
            "city": "CALIMESA",
            "state": "CA",
            "postal_code": "923204921",
            "telephone_number": "909-752-6869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 ORANGE ST STE E",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923743281",
            "telephone_number": "909-752-6869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOTOX SPOT PHYSICIAN ASSISTANT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-25",
        "last_updated": "2023-12-25",
        "certification_date": "2023-12-24",
        "status": "A",
        "authorized_official_last_name": "RUSS",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-752-6869",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Botox Spot",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Botox Spot Physician Assistant Corporation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Ann Teoli, PA-C
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• Alexander Terrazas, MD
• Christina Thaxton
• Ashlea Thayer, LVN
• The Bright Side, Speech Therapy, Inc.
• The Hills of Stillman
• The South Lane II
• Majd Theodory, DDS
• Chance Thepmontry-Nhep

• Medical Specialty Clinic/Center in Redlands, CA
• Providers in Redlands, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.