Provider Demographics
NPI:1114100435
Name:CROWN VALLEY INTERNAL MEDICAL GROUP
Entity Type:Organization
Organization Name:CROWN VALLEY INTERNAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:I
Authorized Official - Last Name:STREGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-1800
Mailing Address - Street 1:26732 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 511
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6306
Mailing Address - Country:US
Mailing Address - Phone:949-364-1800
Mailing Address - Fax:949-364-1877
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 511
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8525
Practice Address - Country:US
Practice Address - Phone:949-364-1800
Practice Address - Fax:949-364-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1406OtherMEDICARE GROUP
CA00G112200Medicaid
CAWG11220BMedicare PIN
CAA38277Medicare UPIN