Healthcare Provider Details

I. General information

NPI: 1598928798
Provider Name (Legal Business Name): CROWNVIEW MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 C AVE
CORONADO CA
92118-1420
US

IV. Provider business mailing address

158 C AVE
CORONADO CA
92118-1420
US

V. Phone/Fax

Practice location:
  • Phone: 619-435-5400
  • Fax: 619-435-5401
Mailing address:
  • Phone: 619-435-5400
  • Fax: 619-435-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK MELDEN
Title or Position: OWNER
Credential: DO
Phone: 619-435-5400