Provider Demographics
NPI:1275643199
Name:ROSS, ALESSANDRA AMY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:AMY ELIZABETH
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1225 MARSHALL ST
Mailing Address - Street 2:STE 7
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2281
Mailing Address - Country:US
Mailing Address - Phone:707-464-1989
Mailing Address - Fax:707-464-9593
Practice Address - Street 1:3770 JANES RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4744
Practice Address - Country:US
Practice Address - Phone:707-826-7846
Practice Address - Fax:707-826-7845
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236659207X00000X
CA128009207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA128009OtherCA MEDICAL LICENSE
CA12652821OtherCAQH