Healthcare Provider Details

I. General information

NPI: 1750298741
Provider Name (Legal Business Name): MICHAEL J ROSS MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N RAYMOND AVE STE 330
PASADENA CA
91103-3947
US

IV. Provider business mailing address

PO BOX 361228
LOS ANGELES CA
90036-9428
US

V. Phone/Fax

Practice location:
  • Phone: 323-457-3536
  • Fax:
Mailing address:
  • Phone: 323-457-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: