Provider Demographics
NPI:1518983055
Name:ROSSI, CARL (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:ROSSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9730 SUMMERS RIDGE RD
Mailing Address - Street 2:SCRIPPS PROTON THERAPY CENTER
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3101
Mailing Address - Country:US
Mailing Address - Phone:858-549-7522
Mailing Address - Fax:
Practice Address - Street 1:9730 SUMMERS RIDGE RD
Practice Address - Street 2:SCRIPPS PROTON THERAPY CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3101
Practice Address - Country:US
Practice Address - Phone:858-549-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG663522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G663520Medicaid
F14972Medicare UPIN
00G663520Medicare ID - Type Unspecified