MEDICARE: LANCE DEROSS

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	2086S0122X	Plastic and Reconstructive Surgery Physician	A194991	CA

General Provider Information

NPI Number	:	1467865725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE DEROSS

Provider Business Mailing Address
First Line	:	19131 WINDWARD WAY
Second Line	:
City	:	COTTONWOOD
State	:	CA
Zip	:	96022-7914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2419 CASTILLO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4301
Country	:	US
Telephone Number	:	805-682-1731
Fax Number	:

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

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	06/03/2024

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Directions to “ LANCE DEROSS ” Practice Location

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