Provider Demographics
NPI:1003268020
Name:RUSSO-NEUSTADT, AMELIA ANGELA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:ANGELA
Last Name:RUSSO-NEUSTADT
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PACIFICA
Mailing Address - Street 2:SUITE 160
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3337
Mailing Address - Country:US
Mailing Address - Phone:949-453-8805
Mailing Address - Fax:
Practice Address - Street 1:101 PACIFICA
Practice Address - Street 2:SUITE 160
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3337
Practice Address - Country:US
Practice Address - Phone:949-453-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0738152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry