Provider Demographics
NPI:1285269035
Name:CROWN CITY ORTHOTICS AND PROSTHETICS LLC.
Entity type:Organization
Organization Name:CROWN CITY ORTHOTICS AND PROSTHETICS LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT OF COMPANY
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:ORTHOTISTS
Authorized Official - Phone:626-432-2890
Mailing Address - Street 1:2824 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3400
Mailing Address - Country:US
Mailing Address - Phone:626-431-2890
Mailing Address - Fax:626-431-2892
Practice Address - Street 1:2824 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3400
Practice Address - Country:US
Practice Address - Phone:626-431-2890
Practice Address - Fax:626-431-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACO003823OtherAMERICAN BOARD ACCREDIDATION (ABC) ORTHOTIST