Provider Demographics
NPI:1477268183
Name:ROSS, DANTE
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 ALTA VIEW DR UNIT A203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-3355
Mailing Address - Country:US
Mailing Address - Phone:619-971-6472
Mailing Address - Fax:
Practice Address - Street 1:2910 ALTA VIEW DR UNIT A203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3355
Practice Address - Country:US
Practice Address - Phone:619-971-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician