Healthcare Provider Details

I. General information

NPI: 1851580005
Provider Name (Legal Business Name): C ROSS M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11755 VICTORY BLVD 240
N HOLLYWOOD CA
91606-3423
US

IV. Provider business mailing address

11755 VICTORY BLVD 240
N HOLLYWOOD CA
91606-3423
US

V. Phone/Fax

Practice location:
  • Phone: 310-466-0449
  • Fax:
Mailing address:
  • Phone: 310-466-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberG46021
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA17995
License Number StateCA

VIII. Authorized Official

Name: DR. CURLEE ROSS
Title or Position: CEO
Credential: M.D.
Phone: 310-466-0449