Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO03377 | CA |
N | 222Z00000X | Podiatrist | CPO03377 | CA |
Y | 224P00000X | Prosthetist | CPO03377 | CA |
NPI | 1437697521 |
---|---|
Provider Name | Mr. Mark Andrew Cromer |
First Address | Fountain Valley, CA 92708-1360 |
Second Address | Fountain Valley, CA 92708-1360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2017 |
Last Update Date | 08/02/2017 |