Provider Demographics
NPI:1346246949
Name:ROSSO, JUDITH ESTHER (DO)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ESTHER
Last Name:ROSSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 VIRGINIA RANCH RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5731
Mailing Address - Country:US
Mailing Address - Phone:775-782-1550
Mailing Address - Fax:775-782-1513
Practice Address - Street 1:1520 VIRGINIA RANCH RD
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5731
Practice Address - Country:US
Practice Address - Phone:775-782-1550
Practice Address - Fax:775-782-1513
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0020088711Medicaid
NV003188711Medicaid
CAXPY187975Medicaid
CAXPY187975Medicaid
NV0020088711Medicaid
NVV100699Medicare PIN