Organization
CROWN CITY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN TYSON (CEO)
(626) 798-8792
Entity
Organization
Contact information
Practice address
6601 RUGBY AVE, # 300, HUNTINGTON PARK, CA 90255-4040
(323) 582-1177
(323) 589-2635
Mailing address
6601 RUGBY AVE, # 300, HUNTINGTON PARK, CA 90255-4040
(323) 582-1177
(323) 589-2635
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0041811
MEDI-CAL PROVIDER #
CA
Enumeration date
04/06/2007
Last updated
08/22/2020
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