Healthcare Provider Details

I. General information

NPI: 1841451465
Provider Name (Legal Business Name): CROWN CITY REHABILITATION INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2693 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

IV. Provider business mailing address

2693 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-8600
  • Fax: 626-296-1403
Mailing address:
  • Phone: 626-798-8600
  • Fax: 626-296-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. M. AMBER AMBER TYSON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 626-798-8600