Healthcare Provider Details

I. General information

NPI: 1265958011
Provider Name (Legal Business Name): ROSS PUSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1898 THE ALAMEDA
SAN JOSE CA
95126-1733
US

IV. Provider business mailing address

1898 THE ALAMEDA
SAN JOSE CA
95126-1733
US

V. Phone/Fax

Practice location:
  • Phone: 408-928-1700
  • Fax: 408-928-1701
Mailing address:
  • Phone: 408-928-1700
  • Fax: 408-928-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: