Provider Demographics
NPI:1023553732
Name:CROSSOVER HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:CROSSOVER HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY AND COMPLIANCE ASSOCIATE
Authorized Official - Prefix:MRS
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 1:19500 E. HOMESTEAD RD.
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:949-891-0328
Practice Address - Fax:949-272-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty