Provider Demographics
NPI:1447555958
Name:ROSS, LEA YVONNE
Entity Type:Individual
Prefix:MS
First Name:LEA
Middle Name:YVONNE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-4126
Mailing Address - Country:US
Mailing Address - Phone:323-234-6261
Mailing Address - Fax:323-264-6265
Practice Address - Street 1:5436 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-4126
Practice Address - Country:US
Practice Address - Phone:323-234-6261
Practice Address - Fax:323-264-6265
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program