Healthcare Provider Details

I. General information

NPI: 1760323745
Provider Name (Legal Business Name): MAISON CROWN IDENTITY SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S ALAMEDA ST FL 2
LOS ANGELES CA
90021-1656
US

IV. Provider business mailing address

777 S ALAMEDA ST FL 2
LOS ANGELES CA
90021-1656
US

V. Phone/Fax

Practice location:
  • Phone: 213-797-0327
  • Fax:
Mailing address:
  • Phone: 213-797-0327
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. EUGENIA ELIZABETH EVERETT
Title or Position: FOUNDER
Credential:
Phone: 213-797-0327