Basic Information
| Provider Information | |||||||||
| NPI: | 1043934649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROSS | ||||||||
| FirstName: | DILLON | ||||||||
| MiddleName: | JAMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24908 SPRINGBROOK WAY | ||||||||
| Address2: | |||||||||
| City: | MENIFEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925847543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512618392 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28999 OLD TOWN FRONT ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925902842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512618392 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2022 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 107422 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.