Provider Demographics
NPI:1326175878
Name:KREMSDORF, ROSS BRYAN (PHD, JD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:BRYAN
Last Name:KREMSDORF
Suffix:
Gender:M
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-3607
Mailing Address - Country:US
Mailing Address - Phone:661-426-5263
Mailing Address - Fax:
Practice Address - Street 1:676 PISMO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3945
Practice Address - Country:US
Practice Address - Phone:805-543-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2018-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical