Provider Demographics
NPI:1366795825
Name:CROSBY, CECILIO EMANUEL
Entity type:Individual
Prefix:
First Name:CECILIO
Middle Name:EMANUEL
Last Name:CROSBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 F ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2666
Mailing Address - Country:US
Mailing Address - Phone:619-746-6978
Mailing Address - Fax:619-779-7081
Practice Address - Street 1:319 F ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2666
Practice Address - Country:US
Practice Address - Phone:619-746-6978
Practice Address - Fax:619-779-7081
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45-3693214251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health