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General NPI Number Information
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NPI Number | 1124481197
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Entity Type | Organization
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Legal Business Name | FERNANDO ROSSO MD LLC
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 8340 MISSION RD STE 210
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66206-1362
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Country | US
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Telephone | 913-642-0100
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Fax | 913-642-0176
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Provider Business Mailing Address
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Address Line | 8340 MISSION RD STE 210
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66206-1362
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Country | US
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Telephone | 913-642-0100
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Fax | 913-642-0176
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Authorized Official
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Title or Position | OWNER
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Name | DR. FERNANDO ROSSO
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Credential | M.D.
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Telephone | 913-642-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 04-22574
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License Number State | KS
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