Healthcare Provider Details

I. General information

NPI: 1760984959
Provider Name (Legal Business Name): ANDREW ROSS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 CASTILLO ST STE A
SANTA BARBARA CA
93105-5308
US

IV. Provider business mailing address

PO BOX 1206
GOLETA CA
93116-1206
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-2541
  • Fax: 805-682-1429
Mailing address:
  • Phone: 805-964-3838
  • Fax: 805-683-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA139763
License Number StateCA

VIII. Authorized Official

Name: ANDREW ROSS
Title or Position: PRESIDENT
Credential: MD
Phone: 949-632-1432