Crown City Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CROWN CITY MEDICAL GROUP INC

Practice address

6601 Rugby Ave
# 300
Huntington Park, CA 90255-4040

Phone

(323) 582-1177

Fax

(323) 589-2635

NPI assigned

Apr 6, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maureen Tyson

Title

Ceo

Phone

(626) 798-8792

Specialties & licenses 1

Addresses

Other identifiers 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508989500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 RUGBY AVE",
            "address_2": "# 300",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554040",
            "telephone_number": "323-582-1177",
            "fax_number": "323-589-2635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 RUGBY AVE",
            "address_2": "# 300",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554040",
            "telephone_number": "323-582-1177",
            "fax_number": "323-589-2635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN CITY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TYSON",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-798-8792"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PROVIDER #",
            "identifier": "GR0041811",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lucia Cota
• Brayan Covarrubias
• Covenant Care California, LLC (Huntington Park Nursing Center)
• Randall Cox Jr.
• Crenshaw Pharmcare,Inc (Slauson Community Pharmacy)
• Zujeid Cruz Flores
• Araseli Cruz
• Marco A. Cruz
• Maria De Jesus Cruz
• Miguel Angel Cruz

• Family Medicine Physician in Huntington Park, CA
• Providers in Huntington Park, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.