Provider Demographics
NPI:1053457762
Name:ALISA A. CROSS, M.D., INC.
Entity Type:Organization
Organization Name:ALISA A. CROSS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-466-8300
Mailing Address - Street 1:6464 W SUNSET BLVD STE 1040
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8012
Mailing Address - Country:US
Mailing Address - Phone:323-466-8300
Mailing Address - Fax:323-466-8380
Practice Address - Street 1:6464 W SUNSET BLVD STE 1040
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-8012
Practice Address - Country:US
Practice Address - Phone:323-466-8300
Practice Address - Fax:323-466-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15933Medicare UPIN