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General NPI Number Information
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NPI Number | 1104146968
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Entity Type | Organization
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Legal Business Name | MICHAEL L CROSS MD, A PROFESSIONAL
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 36320 INLAND VALLEY DR SUITE 201
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City | WILDOMAR
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State | CA
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Zip | 92595-7512
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Country | US
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Telephone | 951-698-3000
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Fax | 951-698-7700
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Provider Business Mailing Address
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Address Line | 36320 INLAND VALLEY DR SUITE 201
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City | WILDOMAR
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State | CA
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Zip | 92595-7512
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Country | US
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Telephone | 951-698-3000
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Fax | 951-698-7700
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. MICHAEL LEE CROSS
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Credential | MD
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Telephone | 951-698-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G060487
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License Number State | CA
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