Basic Information
| Provider Information | |||||||||
| NPI: | 1841451465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROWN CITY REHABILITATION INSTITUTE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2693 E WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267988600 | ||||||||
| FaxNumber: | 6262961403 | ||||||||
| Practice Location | |||||||||
| Address1: | 2693 E WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267988600 | ||||||||
| FaxNumber: | 6262961403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2008 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | TYSON | ||||||||
| AuthorizedOfficialFirstName: | M. AMBER | ||||||||
| AuthorizedOfficialMiddleName: | AMBER | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6267988600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.