MEDICARE: DR. CAROLYN COKER ROSS M.D.

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
1	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	A37347	CA

General Provider Information

NPI Number	:	1386785657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN COKER ROSS M.D.

Provider Business Mailing Address
First Line	:	8775 AERO DR STE 238
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1756
Country	:	US
Telephone Number	:	619-930-9524
Fax Number	:	619-269-9245

Provider Business Practice Location Address
First Line	:	3940 DOVE ST UNIT 207
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2961
Country	:	US
Telephone Number	:	520-440-0079
Fax Number	:	855-651-2323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	05/15/2025

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