MEDICARE: ELSIE ROSS MEDICAL CORPORATION

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	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1619832326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELSIE ROSS MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	3601 VISTA WAY STE 203
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 VISTA WAY STE 203
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4559
Country	:	US
Telephone Number	:	760-724-5352
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELSIE ROSS
Credential	:	MD
Telephone Number	:	650-228-4858

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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