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General NPI Number Information
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NPI Number | 1285269035
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Entity Type | Organization
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Legal Business Name | CROWN CITY ORTHOTICS AND PROSTHETICS LLC.
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 2824 E FOOTHILL BLVD
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City | PASADENA
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State | CA
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Zip | 91107-3400
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Country | US
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Telephone | 626-431-2890
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Fax | 626-431-2892
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Provider Business Mailing Address
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Address Line | 2824 E FOOTHILL BLVD
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City | PASADENA
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State | CA
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Zip | 91107-3400
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Country | US
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Telephone | 626-431-2890
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Fax | 626-431-2892
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Authorized Official
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Title or Position | CEO/PRESIDENT OF COMPANY
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Name | MR. RYAN P MOLINA
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Credential | ORTHOTISTS
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Telephone | 626-432-2890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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