Provider Demographics
NPI:1215023411
Name:ROSSO, RONALD FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FRANK
Last Name:ROSSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LOMITA BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4909
Mailing Address - Country:US
Mailing Address - Phone:310-326-3636
Mailing Address - Fax:310-326-6448
Practice Address - Street 1:3400 LOMITA BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4909
Practice Address - Country:US
Practice Address - Phone:310-326-3636
Practice Address - Fax:310-326-6448
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 079401Medicare UPIN