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General NPI Number Information
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NPI Number | 1386785657
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Entity Type | Individual
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Provider Name | CAROLYN COKER ROSS M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 3940 DOVE ST UNIT 207
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City | SAN DIEGO
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State | CA
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Zip | 92103-2961
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Country | US
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Telephone | 520-440-0079
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Fax | 855-651-2323
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Provider Business Mailing Address
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Address Line | 8775 AERO DR STE 238
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City | SAN DIEGO
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State | CA
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Zip | 92123-1756
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Country | US
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Telephone | 619-930-9524
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Fax | 619-269-9245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | A37347
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License Number State | CA
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