Provider Demographics
NPI:1144380825
Name:ROSS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ROSS MEDICAL GROUP INC
Other - Org Name:LINDA B ROSS MD APC LINDA B ROSS MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-287-2046
Mailing Address - Street 1:PO BOX 9575
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-4575
Mailing Address - Country:US
Mailing Address - Phone:858-759-0731
Mailing Address - Fax:858-759-0966
Practice Address - Street 1:6719 ALVARADO ROAD
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5252
Practice Address - Country:US
Practice Address - Phone:619-287-2046
Practice Address - Fax:858-759-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42001207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G420010OtherBLUE SHIELD
CA00G420010OtherBLUE SHIELD
CA00G420010OtherBLUE SHIELD
A48771Medicare UPIN