MEDICARE: SHARON ROSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		CA
2	106H00000X	Marriage & Family Therapist	45723	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100405	OTHER	CA	STAFF ID NUMBER

General Provider Information

NPI Number	:	1467648501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON ROSS

Provider Business Mailing Address
First Line	:	3636 N 1ST ST STE 158
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6871
Country	:	US
Telephone Number	:	559-221-5191
Fax Number	:	559-221-0307

Provider Business Practice Location Address
First Line	:	3636 N 1ST ST STE 158
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6871
Country	:	US
Telephone Number	:	559-221-5191
Fax Number	:	559-221-0307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	09/10/2015

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Directions to “ SHARON ROSS ” Practice Location

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