Basic Information
| Provider Information | |||||||||
| NPI: | 1275643199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | ALESSANDRA | ||||||||
| MiddleName: | AMY ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 MARSHALL ST | ||||||||
| Address2: | STE 7 | ||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955312281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074641989 | ||||||||
| FaxNumber: | 7074649593 | ||||||||
| Practice Location | |||||||||
| Address1: | 3770 JANES RD | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955214744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078267846 | ||||||||
| FaxNumber: | 7078267845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0101236659 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 128009 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | A128009 | 01 | CA | CA MEDICAL LICENSE | OTHER | 12652821 | 01 | CA | CAQH | OTHER |