Basic Information
| Provider Information | |||||||||
| NPI: | 1598957086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 628 W MICHELTORENA ST | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931014131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059681511 | ||||||||
| FaxNumber: | 8056852467 | ||||||||
| Practice Location | |||||||||
| Address1: | 628 W MICHELTORENA ST | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931014131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059681511 | ||||||||
| FaxNumber: | 8056852467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2007 | ||||||||
| LastUpdateDate: | 08/17/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | GG20577 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | G20577 | 01 | CA | STATE LICENSE | OTHER | AR5768037 | 01 | CA | DEA | OTHER |