Provider Demographics
NPI:1972034346
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
Authorized Official - Prefix:
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 1:15 ENTERPRISE
Mailing Address - Street 2:#300
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2652
Mailing Address - Country:US
Mailing Address - Phone:949-891-0328
Mailing Address - Fax:
Practice Address - Street 1:30 ROCKEFELLER PLZ
Practice Address - Street 2:924E-4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10112-0015
Practice Address - Country:US
Practice Address - Phone:949-891-0328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty