Provider Demographics
NPI:1902313174
Name:CROSSOVER HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:CROSSOVER HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKIOKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-891-0328
Mailing Address - Street 1:101 W AVENIDA VISTA HERMOSA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-7706
Mailing Address - Country:US
Mailing Address - Phone:949-891-0328
Mailing Address - Fax:949-272-0159
Practice Address - Street 1:1286 SANCHEZ ST STE A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3833
Practice Address - Country:US
Practice Address - Phone:949-891-0328
Practice Address - Fax:949-272-0159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSOVER HEALTH MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty