Basic Information
| Provider Information | |||||||||
| NPI: | 1366777344 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROSS MEDICAL ASSOCIATES SAN JUAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26161 MARGUERITE PKWY | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926923203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495828584 | ||||||||
| FaxNumber: | 9495822943 | ||||||||
| Practice Location | |||||||||
| Address1: | 32312 CAMINO CAPISTRANO | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN CAPISTRANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926754533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494899112 | ||||||||
| FaxNumber: | 9494891231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2009 | ||||||||
| LastUpdateDate: | 01/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | GEBHARD | ||||||||
| AuthorizedOfficialFirstName: | KARL | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9495828584 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.