Maria Susena Ross

Individual provider Active NPI School Registered Nurse · Gustine, CA

NPI 1174155485 · NPPES record last updated Feb 5, 2020

Key facts

NPI
1174155485
Entity type
Individual (NPI type 1)
Primary specialty
School Registered Nurse 163WS0200X
License
95096064 (CA)
Practice address
1500 Meredith Ave
Gustine, CA 95322-1701
Phone
(209) 600-2102
NPI assigned
Feb 5, 2020
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
95096064CAMDSchool Registered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered Nurse
Group: 193400000X SINGLE SPECIALTY GROUP
163WS0200X 95096064 CA Yes

Addresses

Primary practice location

1500 Meredith Ave
Gustine, CA 95322-1701

Mailing address

1500 Meredith Ave
Gustine, CA 95322-1701
Phone (209) 600-2102

Other providers in Gustine, CA

All providers in Gustine, CA · School Registered Nurse in California

Sources for this page

Verify at the official NPI Registry.