Provider Demographics
NPI:1255632576
Name:ROSS, JENNIFER ERIN (LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ERIN
Last Name:ROSS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 66TH ST
Mailing Address - Street 2:APT. A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1189
Mailing Address - Country:US
Mailing Address - Phone:707-738-7323
Mailing Address - Fax:
Practice Address - Street 1:703 MARKET ST
Practice Address - Street 2:STE. 514
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2102
Practice Address - Country:US
Practice Address - Phone:415-298-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13781171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist