Provider Demographics
NPI:1992022123
Name:CROWN MEDICAL GROUP
Entity Type:Organization
Organization Name:CROWN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:HAZEL
Authorized Official - Last Name:CALINISAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-677-0215
Mailing Address - Street 1:24013 KALEB DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-9387
Mailing Address - Country:US
Mailing Address - Phone:951-603-3088
Mailing Address - Fax:
Practice Address - Street 1:25470 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4900
Practice Address - Country:US
Practice Address - Phone:951-677-0215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385348261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty