Organization
CROWN CITY MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN B. TYSON (CEO)
(626) 798-8792
Entity
Organization
Contact information
Practice address
3208 SANTA ANITA AVE, # 200, EL MONTE, CA 91733-1360
(626) 454-1990
(626) 454-1995
Mailing address
3208 SANTA ANITA AVE, # 200, EL MONTE, CA 91733-1360
(626) 454-1990
(626) 454-1995
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0041812
MEDI-CAL PROVIDER #
CA
Enumeration date
04/06/2007
Last updated
08/22/2020
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