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General NPI Number Information
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NPI Number | 1205964939
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Entity Type | Individual
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Provider Name | MARK CROSS PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 560 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3269
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Country | US
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Telephone | 559-781-1665
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Fax | 559-781-6036
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Provider Business Mailing Address
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Address Line | 2050 S BLOSSER RD
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City | SANTA MARIA
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State | CA
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Zip | 93458-7310
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Country | US
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Telephone | 805-361-8017
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Fax | 805-361-8097
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2322
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 19505
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 19505
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License Number State | CA
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