Basic Information
| Provider Information | |||||||||
| NPI: | 1346246949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSSO | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | ESTHER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1520 VIRGINIA RANCH RD | ||||||||
| Address2: | |||||||||
| City: | GARDNERVILLE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894105731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757821550 | ||||||||
| FaxNumber: | 7757821513 | ||||||||
| Practice Location | |||||||||
| Address1: | 1520 VIRGINIA RANCH RD | ||||||||
| Address2: | |||||||||
| City: | GARDNERVILLE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894105731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757821550 | ||||||||
| FaxNumber: | 7757821513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 06/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 750 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0020088711 | 05 | NV | MEDICAID | 003188711 | 05 | NV | MEDICAID | XPY187975 | 05 | CA | MEDICAID |