Provider Demographics
NPI:1376615666
Name:ROSSI, STACY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:ROSSI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 UNIVERSITY CENTER LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1006
Mailing Address - Country:US
Mailing Address - Phone:858-657-0000
Mailing Address - Fax:858-657-0003
Practice Address - Street 1:8929 UNIVERSITY CENTER LN
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1006
Practice Address - Country:US
Practice Address - Phone:858-657-0000
Practice Address - Fax:858-657-0003
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17674363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 17674OtherLICENSE NUMBER