Provider Demographics
NPI:1891342838
Name:ROSS, LORI (PA-C)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ROSS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POTRETO AVENUE
Mailing Address - Street 2:BUILDING 5, 4J
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:628-206-1000
Mailing Address - Fax:628-206-2658
Practice Address - Street 1:1001 POTRETO AVE
Practice Address - Street 2:BUILDING 5, CLINIC 4J
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:628-206-1000
Practice Address - Fax:628-206-2658
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA58345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant