Basic Information
| Provider Information | |||||||||
| NPI: | 1699119081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | SINGSON | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SINGSON | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | VALENCIA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 325 DISTEL CIR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048189 | ||||||||
| FaxNumber: | 5105067724 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 CAMINO ENCINAS | ||||||||
| Address2: | |||||||||
| City: | ORINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945633304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048189 | ||||||||
| FaxNumber: | 5105067724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2013 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A136701 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A136701 | 01 | CA | STATE MEDICAL LICENSE | OTHER |