Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LCS7205 | CA |
Y | 103T00000X | Psychologist | LCS7205 | CA |
NPI | 1003914052 |
---|---|
Provider Name | Ms. Karen Sue Ross |
First Address | Garden Grove, CA 92840-4691 |
Second Address | Garden Grove, CA 92840-4691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S31947 | (02) |