Healthcare Provider Details

I. General information

NPI: 1538897202
Provider Name (Legal Business Name): CROSSOVER HEALTH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 106TH AVE NE STE 402
BELLEVUE WA
98004-5965
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: 949-891-0328
  • Fax:
Mailing address:
  • Phone: 949-891-0328
  • Fax:

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: OPERATIONS SPECIALIST
Credential:
Phone: 949-891-0228