Provider Demographics
NPI:1699119081
Name:ROSS, STEPHANIE SINGSON
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SINGSON
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:VALENCIA
Other - Last Name:SINGSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-8189
Mailing Address - Fax:510-506-7724
Practice Address - Street 1:12 CAMINO ENCINAS
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3304
Practice Address - Country:US
Practice Address - Phone:510-204-8189
Practice Address - Fax:510-506-7724
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136701207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA136701OtherSTATE MEDICAL LICENSE