Healthcare Provider Details

I. General information

NPI: 1669668190
Provider Name (Legal Business Name): SHERI R FAGO CROS D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71843 HIGHWAY 111 SUITE A
RANCHO MIRAGE CA
92270-4418
US

IV. Provider business mailing address

71843 HIGHWAY 111 SUITE A
RANCHO MIRAGE CA
92270-4418
US

V. Phone/Fax

Practice location:
  • Phone: 760-444-3202
  • Fax: 760-444-3229
Mailing address:
  • Phone: 760-444-3202
  • Fax: 760-444-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number58148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: