Basic Information
| Provider Information | |||||||||
| NPI: | 1417028192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | SORAYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHYSICIAN ASSISTANT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BARRAZA | ||||||||
| OtherFirstName: | SORAYA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2503 LAS LOMITAS DR | ||||||||
| Address2: | |||||||||
| City: | HACIENDA HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917455133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262527899 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6901 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | BELL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902013646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233266700 | ||||||||
| FaxNumber: | 3235629208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA15676 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.