Healthcare Provider Details

I. General information

NPI: 1952369290
Provider Name (Legal Business Name): ROSS MEDICAL ASSOCIATES LADERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CORPORATE DR SUITE 100
LADERA RANCH CA
92694-1152
US

IV. Provider business mailing address

800 CORPORATE DR SUITE 100
LADERA RANCH CA
92694-1152
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-9112
  • Fax: 949-364-9016
Mailing address:
  • Phone: 949-364-9112
  • Fax: 949-364-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC28419
License Number StateCA

VIII. Authorized Official

Name: KARL GEBHARD
Title or Position: OWNER
Credential: MD
Phone: 949-364-9112