Provider Demographics
NPI:1316995962
Name:ROSS MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:ROSS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-589-9112
Mailing Address - Street 1:22032 EL PASEO
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3947
Mailing Address - Country:US
Mailing Address - Phone:949-589-9112
Mailing Address - Fax:949-589-9338
Practice Address - Street 1:22032 EL PASEO
Practice Address - Street 2:SUITE 130
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3947
Practice Address - Country:US
Practice Address - Phone:949-589-9112
Practice Address - Fax:949-589-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28419174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0998835OtherCLIA WAIVER