Provider Demographics
NPI:1801250154
Name:ROSS, KRISTEN (ATC)
Entity type:Individual
Prefix:MR
First Name:KRISTEN
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3822
Mailing Address - Country:US
Mailing Address - Phone:310-213-0861
Mailing Address - Fax:
Practice Address - Street 1:4219 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3822
Practice Address - Country:US
Practice Address - Phone:310-213-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer