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General NPI Number Information
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NPI Number | 1851762967
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Entity Type | Individual
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Provider Name | KELLY CROSS
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Gender | Female
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 43585 MONTEREY AVE STE 8
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City | PALM DESERT
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State | CA
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Zip | 92260-9400
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Country | US
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Telephone | 760-831-1355
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Fax |
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Provider Business Mailing Address
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Address Line | 72286 DESERT DR
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4918
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Country | US
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Telephone | 760-831-1355
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 19056
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License Number State | CA
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