Provider Demographics
NPI:1518254531
Name:ROSS, TANNER E (DVM)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:E
Last Name:ROSS
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32844 WOLF STORE RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8209
Mailing Address - Country:US
Mailing Address - Phone:951-302-7595
Mailing Address - Fax:
Practice Address - Street 1:32844 WOLF STORE RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-8209
Practice Address - Country:US
Practice Address - Phone:951-302-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVT60109329174M00000X
CA18323174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian