Healthcare Provider Details

I. General information

NPI: 1629614086
Provider Name (Legal Business Name): CROSSOVER HEALTH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HAMILTON AVE
MENLO PARK CA
94025-1431
US

IV. Provider business mailing address

101 W AVENIDA VISTA HERMOSA STE 120
SAN CLEMENTE CA
92672-7707
US

V. Phone/Fax

Practice location:
  • Phone: 408-665-3726
  • Fax: 669-255-0666
Mailing address:
  • Phone: 408-665-3726
  • Fax: 669-255-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGIE SAKIOKA
Title or Position: HR OPERATIONS SPECIALIST
Credential:
Phone: 949-891-0228