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General NPI Number Information
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NPI Number | 1760942304
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Entity Type | Individual
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Provider Name | GUSTAVE JOHN ROSSI JR. MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 3100 N. TENAYA WAY GRADUATE MEDICAL EDUCATION
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City | LAS VEGAS
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State | NV
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Zip | 89128-0431
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Country | US
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Telephone | 702-962-5634
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Fax |
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Provider Business Mailing Address
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Address Line | 3390 N CAMPBELL AVE STE 110
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City | TUCSON
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State | AZ
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Zip | 85719-2380
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Country | US
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Telephone |
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 69682
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License Number State | AZ
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