Provider Demographics
NPI:1699133090
Name:CROSMER, MICHELE (RD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CROSMER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8431 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4544
Mailing Address - Country:US
Mailing Address - Phone:909-912-4060
Mailing Address - Fax:
Practice Address - Street 1:123 E 9TH ST
Practice Address - Street 2:STE 320
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6023
Practice Address - Country:US
Practice Address - Phone:909-912-4060
Practice Address - Fax:888-974-4248
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86014375133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered