Provider Demographics
NPI:1417028192
Name:ROSS, SORAYA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:SORAYA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:SORAYA
Other - Middle Name:
Other - Last Name:BARRAZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2503 LAS LOMITAS DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-5133
Mailing Address - Country:US
Mailing Address - Phone:626-252-7899
Mailing Address - Fax:
Practice Address - Street 1:6901 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3646
Practice Address - Country:US
Practice Address - Phone:323-326-6700
Practice Address - Fax:323-562-9208
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15676363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ31726Medicare UPIN