Healthcare Provider Details

I. General information

NPI: 1538693718
Provider Name (Legal Business Name): JENNIFER LEIGH ANN ROSS MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PROFESSIONAL DR
NAPA CA
94558-6413
US

IV. Provider business mailing address

1001 PROFESSIONAL DR
NAPA CA
94558-6413
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-0494
  • Fax:
Mailing address:
  • Phone: 707-252-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA134506
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number134506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: