Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | A37347 | CA |
NPI | 1386785657 |
---|---|
Provider Name | Dr. Carolyn Coker Ross |
First Address | San Diego, CA 92103-1858 |
Second Address | San Diego, CA 92103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 07/08/2018 |