Provider Demographics
NPI:1568675254
Name:MACROHON-CROSS, LIZA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:
Last Name:MACROHON-CROSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8426 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2414
Mailing Address - Country:US
Mailing Address - Phone:323-249-1100
Mailing Address - Fax:323-249-1103
Practice Address - Street 1:8426 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2414
Practice Address - Country:US
Practice Address - Phone:323-249-1100
Practice Address - Fax:323-249-1103
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 13082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 13082OtherPHYSICIAN ASSISTANT