Provider Demographics
NPI:1851403513
Name:CROSSROADS IN HEALTH
Entity Type:Organization
Organization Name:CROSSROADS IN HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:TROMELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:805-480-0499
Mailing Address - Street 1:558 N VENTU PARK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2718
Mailing Address - Country:US
Mailing Address - Phone:805-480-0499
Mailing Address - Fax:805-480-0866
Practice Address - Street 1:558 N VENTU PARK RD
Practice Address - Street 2:SUITE B
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2718
Practice Address - Country:US
Practice Address - Phone:805-480-0499
Practice Address - Fax:805-480-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF7530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty