Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | A94455 | CA |
Y | 208000000X | Pediatrician | A94455 | CA |
NPI | 1558530808 |
---|---|
Provider Name | Dr. Corinn Cross |
First Address | Los Angeles, CA 90010-2804 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2008 |
Last Update Date | 13/12/2018 |