Provider Demographics
NPI:1790974939
Name:ROSS, CURLEE (MD)
Entity Type:Individual
Prefix:
First Name:CURLEE
Middle Name:
Last Name:ROSS
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 1:11755 VICTORY BLVD
Mailing Address - Street 2:240
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3423
Mailing Address - Country:US
Mailing Address - Phone:310-466-0449
Mailing Address - Fax:
Practice Address - Street 1:11755 VICTORY BLVD
Practice Address - Street 2:240
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3423
Practice Address - Country:US
Practice Address - Phone:310-466-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17995208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA17995Medicare PIN