Healthcare Provider Details

I. General information

NPI: 1285269035
Provider Name (Legal Business Name): CROWN CITY ORTHOTICS AND PROSTHETICS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 E FOOTHILL BLVD
PASADENA CA
91107-3400
US

IV. Provider business mailing address

2824 E FOOTHILL BLVD
PASADENA CA
91107-3400
US

V. Phone/Fax

Practice location:
  • Phone: 626-431-2890
  • Fax: 626-431-2892
Mailing address:
  • Phone: 626-431-2890
  • Fax: 626-431-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN P MOLINA
Title or Position: CEO/PRESIDENT OF COMPANY
Credential: ORTHOTISTS
Phone: 626-432-2890