MEDICARE: FAUSTINE ROSS LCSW

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	1041C0700X	Clinical Social Worker	LCS 27246	CA

General Provider Information

NPI Number	:	1497953061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAUSTINE ROSS LCSW

Provider Business Mailing Address
First Line	:	7410 MISSION VALLEY ROAD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108
Country	:	US
Telephone Number	:	619-497-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 MISSION VALLEY RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4405
Country	:	US
Telephone Number	:	619-497-8989
Fax Number	:

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	09/04/2014

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