Provider Demographics
NPI:1053572776
Name:CROSS, SALLY ANN (CLIN LAB SCIENTIST)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:CROSS
Suffix:
Gender:F
Credentials:CLIN LAB SCIENTIST
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Mailing Address - Street 1:8600 TUSCANY AVE
Mailing Address - Street 2:#205
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8696
Mailing Address - Country:US
Mailing Address - Phone:310-578-9767
Mailing Address - Fax:310-823-1404
Practice Address - Street 1:8600 TUSCANY AVE
Practice Address - Street 2:#205
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8696
Practice Address - Country:US
Practice Address - Phone:310-578-9767
Practice Address - Fax:310-823-1404
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAMTA28294246QM0706X
CAASCP #134302246QM0706X
CAASCP #1587246QM0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology