Provider Demographics
NPI:1992191555
Name:ROSS, TONI MICHELLE I
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:MICHELLE
Last Name:ROSS
Suffix:I
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 1:18501 GALE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1359
Mailing Address - Country:US
Mailing Address - Phone:626-626-4997
Mailing Address - Fax:
Practice Address - Street 1:18501 GALE AVE STE 100
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1359
Practice Address - Country:US
Practice Address - Phone:626-626-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35272167G00000X
CALPT35272167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician