Healthcare Provider Details

I. General information

NPI: 1275495111
Provider Name (Legal Business Name): MR. TRAVIS JAMES ROSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 S BROADWAY ST STE 205
ORCUTT CA
93455-4656
US

IV. Provider business mailing address

461 BALD EAGLE DR
VACAVILLE CA
95688-1019
US

V. Phone/Fax

Practice location:
  • Phone: 805-552-5239
  • Fax:
Mailing address:
  • Phone: 707-400-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-7939-885985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: