Provider Demographics
NPI:1386785657
Name:ROSS, CAROLYN COKER (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:COKER
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 FALCON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1858
Mailing Address - Country:US
Mailing Address - Phone:520-440-0079
Mailing Address - Fax:855-651-2323
Practice Address - Street 1:4080 FALCON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:520-440-0079
Practice Address - Fax:855-651-2323
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37347207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine