Provider Demographics
NPI:1881764777
Name:CROWN MEDICAL GROUP INC
Entity type:Organization
Organization Name:CROWN MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FESTUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-973-7290
Mailing Address - Street 1:25470 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4900
Mailing Address - Country:US
Mailing Address - Phone:951-677-0215
Mailing Address - Fax:951-677-0991
Practice Address - Street 1:25470 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-677-0215
Practice Address - Fax:951-296-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID