Healthcare Provider Details

I. General information

NPI: 1619832326
Provider Name (Legal Business Name): ELSIE ROSS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 VISTA WAY STE 203
OCEANSIDE CA
92056-4559
US

IV. Provider business mailing address

3601 VISTA WAY STE 203
OCEANSIDE CA
92056-4559
US

V. Phone/Fax

Practice location:
  • Phone: 760-724-5352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ELSIE ROSS
Title or Position: PRESIDENT
Credential: MD
Phone: 650-228-4858