MEDICARE: SAN CROSS MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	G57286	CA

General Provider Information

NPI Number	:	1861636144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN CROSS MEDICAL

Provider Business Mailing Address
First Line	:	14080 PALM DR
Second Line	:	SUTIE D-506
City	:	DESERT HOT SPRINGS
State	:	CA
Zip	:	92240-6851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14080 PALM DR
Second Line	:	SUTIE D-506
City	:	DESERT HOT SPRINGS
State	:	CA
Zip	:	92240-6851
Country	:	US
Telephone Number	:	760-880-6870
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFFREY L HENDEL
Credential	:	MD
Telephone Number	:	760-880-6870

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	08/31/2009

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