Basic Information
| Provider Information | |||||||||
| NPI: | 1932336757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSSO | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | JOYCE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KIELBOWICZ | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | JOYCE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14416 W MEEKER BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853755284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238763880 | ||||||||
| FaxNumber: | 6232852710 | ||||||||
| Practice Location | |||||||||
| Address1: | 14416 W MEEKER BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238763880 | ||||||||
| FaxNumber: | 6232852710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2009 | ||||||||
| LastUpdateDate: | 07/06/2018 | ||||||||
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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 | 2086X0206X | 54310 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.