Provider Demographics
NPI:1326068511
Name:ROSS, STEPHEN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHARLES
Last Name:ROSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-458-2381
Mailing Address - Fax:310-260-2963
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#365,530,420,120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-458-2381
Practice Address - Fax:310-260-2963
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-02-09
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Provider Licenses
StateLicense IDTaxonomies
CAG37284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G372840Medicaid
CA00G372840Medicaid
CAWG37284BMedicare PIN