Provider Demographics
NPI:1235185992
Name:ROSS, CATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 SONOMA AVE
Mailing Address - Street 2:113
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-545-2082
Mailing Address - Fax:707-545-2083
Practice Address - Street 1:1144 SONOMA AVE
Practice Address - Street 2:113
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-545-2082
Practice Address - Fax:707-545-2083
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG25531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics