Provider Demographics
NPI:1437697521
Name:CROMER, MARK ANDREW (CPO)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:CROMER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16520 HARBOR BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1360
Mailing Address - Country:US
Mailing Address - Phone:714-210-1298
Mailing Address - Fax:714-210-1336
Practice Address - Street 1:16520 HARBOR BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1360
Practice Address - Country:US
Practice Address - Phone:714-210-1298
Practice Address - Fax:714-210-1336
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACPO03377222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist