Healthcare Provider Details

I. General information

NPI: 1083361802
Provider Name (Legal Business Name): YANCI ELENA ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NE KELLY AVE # 100C
GRESHAM OR
97030-5629
US

IV. Provider business mailing address

2821 NE EVERETT ST APT 408
PORTLAND OR
97232-3598
US

V. Phone/Fax

Practice location:
  • Phone: 503-912-5502
  • Fax:
Mailing address:
  • Phone: 971-354-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberA960796
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: