Healthcare Provider Details

I. General information

NPI: 1639381759
Provider Name (Legal Business Name): JARON ROSS ANDERSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14642 NEWPORT AVE STE 105
TUSTIN CA
92780-6058
US

IV. Provider business mailing address

14642 NEWPORT AVE STE 105
TUSTIN CA
92780-6058
US

V. Phone/Fax

Practice location:
  • Phone: 949-688-0958
  • Fax: 949-688-0960
Mailing address:
  • Phone: 949-688-0958
  • Fax: 949-688-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME106838
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA97202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: