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NPI Code Detail

MEDICARE: GINA ROSS MFC

MEDICARE: GINA ROSS MFC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist22453CA

General Provider Information

NPI Number : 1083786503
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA ROSS MFC
Provider Business Mailing Address
First Line : 269 SOUTH LORRAINE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-3811
Country : US
Telephone Number : 323-930-2151
Fax Number : 323-935-8417
Provider Business Practice Location Address
First Line : 269 LORRAINE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-3811
Country : US
Telephone Number : 323-930-2151
Fax Number : 323-935-8417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 07/08/2007

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Directions to “ GINA ROSS MFC” Practice Location

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