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General NPI Number Information
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NPI Number | 1871568006
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Entity Type | Individual
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Provider Name | LESLEY SUZANNE ROSS MD
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Gender | Female
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 34800 BOB WILSON DR
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City | SAN DIEGO
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State | CA
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Zip | 92134-1002
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Country | US
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Telephone | 619-532-5761
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Fax |
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Provider Business Mailing Address
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Address Line | 3468 BRANDYWINE ST
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City | SAN DIEGO
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State | CA
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Zip | 92117-5604
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Country | US
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Telephone | 202-309-4636
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C53982
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License Number State | CA
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