Provider Demographics
NPI:1407672538
Name:ROSSI, STEPHEN ANDREW
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ANDREW
Last Name:ROSSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E DYER RD UNIT 159
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5768
Mailing Address - Country:US
Mailing Address - Phone:760-815-8902
Mailing Address - Fax:
Practice Address - Street 1:1901 E DYER RD UNIT 159
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5768
Practice Address - Country:US
Practice Address - Phone:760-815-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant