Organization Name: | CROSS MEDICAL CLINIC PLLC |
NPI Number: | 1366879314 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLORIA RODRIGUEZ FULLER (OWNER) |
Mailing Address: | 1619 4th Ave Canyon |
State: | TX US |
Postal Code: | 790153824 |
Phone Number: | 8064185880 |
Fax Number: | |
NPI Enumeration Date: | 10/06/2013 |
NPI Last Update Date: | 10/14/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 694365 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |