Healthcare Provider Details

I. General information

NPI: 1043934649
Provider Name (Legal Business Name): DILLON JAMES CROSS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 LATHAM ST STE 110
RIVERSIDE CA
92501-1773
US

IV. Provider business mailing address

24908 SPRINGBROOK WAY
MENIFEE CA
92584-7543
US

V. Phone/Fax

Practice location:
  • Phone: 951-265-7610
  • Fax:
Mailing address:
  • Phone: 951-261-8392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: