Healthcare Provider Details

I. General information

NPI: 1699304741
Provider Name (Legal Business Name): AMY ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 N LITCHFIELD RD STE 120
GOODYEAR AZ
85395-7831
US

IV. Provider business mailing address

4001 N 3RD ST STE 290
PHOENIX AZ
85012-2071
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-5780
  • Fax: 623-935-5783
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-001085
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: