Crown City Medical Group

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

CROWN CITY MEDICAL GROUP

Practice address

1800 N Western Ave
Suite 403
San Bernardino, CA 92411

Phone

(909) 887-3087

Fax

(909) 887-2974

NPI assigned

Aug 5, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Maureen B Tyson

Title

Chief Executive Officer

Phone

(626) 798-8792

Specialties & licenses 2

Addresses

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Oscar S. Devera, M.D.

  • Pediatrics Physician
  • El Monte, CA
  • NPI 1205946639
  NPD (past)
• Walfredo Iniguez, M.D.

  • Pediatrics Physician
  • Huntington Park, CA
  • NPI 1255441697
  NPD (past)
• Kevin Bertrand Tyson, MD

  • Internal Medicine Physician
  • Pasadena, CA
  • NPI 1194723874
  NPD (past)
• Juventino Villanueva

  • Pediatrics Physician
  • Huntington Park, CA
  • NPI 1164532446
  NPD (past)

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

{
    "created_epoch": "1375660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375660800000",
    "number": "1649602384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2589 E WASHINGTON BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071446",
            "telephone_number": "626-798-8792",
            "fax_number": "626-296-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 N WESTERN AVE",
            "address_2": "SUITE 403",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92411",
            "telephone_number": "909-887-3087",
            "fax_number": "909-887-2974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN CITY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-05",
        "last_updated": "2013-08-05",
        "status": "A",
        "authorized_official_last_name": "TYSON",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "626-798-8792",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Crosby
• Reginald Crosby, RADI
• Niana L. Cross
• Rosemarie Cross
• Crossover Health Medical Group
• Crown Concordia Dental Network
• Eugene Crowther
• Zitlaly Lizeth Cruz-Roman
• Bernard Nunez Cruz
• Chrystal Mye Cruz

• Pediatrics Physician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; 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.