Provider Demographics
NPI:1003584285
Name:CROSS, LISA (FNTP, RWP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:FNTP, RWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16522 FARLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16522 FARLEY RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3518
Practice Address - Country:US
Practice Address - Phone:408-242-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date: