Basic Information
| Provider Information | |||||||||
| NPI: | 1619544657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | CIERRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6775 SELMA AVE APT 623 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136959953 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 EMBARCADERO CTR | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941113628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156445265 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2021 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | NY | N | Other Service Providers | Health Educator | 174H00000X | WA | N | Other Service Providers | Health Educator | 174H00000X | DC | N | Other Service Providers | Health Educator | 174H00000X | CA | Y | Other Service Providers | Health Educator |
No ID Information.