MEDICARE: MR. CHRISTOPHER ALLAN CROSDALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1568862175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER ALLAN CROSDALE

Provider Business Mailing Address
First Line	:	4420 HOTEL CIRCLE CT STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3423
Country	:	US
Telephone Number	:	626-698-8240
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 HOTEL CIRCLE CT STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3423
Country	:	US
Telephone Number	:	626-698-8240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	02/21/2024

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