1558665893 NPI number — ANITA M. ROYBAL FAMILY AND PREVENTIVE HEALTH, LLC

Table of content: (NPI 1558665893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558665893 NPI number — ANITA M. ROYBAL FAMILY AND PREVENTIVE HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANITA M. ROYBAL FAMILY AND PREVENTIVE HEALTH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558665893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 JACKIE RD SE STE 400
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
RIO RANCHO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87124-1045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-234-1612
Provider Business Mailing Address Fax Number:
505-234-1618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1316 JACKIE RD SE STE 400
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
RIO RANCHO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87124-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-234-1612
Provider Business Practice Location Address Fax Number:
505-234-1618
Provider Enumeration Date:
12/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ROYBAL
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
505-234-1612

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  84110 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NMB2482 . This is a "GROUP PTAN NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q6735 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: NMB2482 . This is a "GROUP PTAN NUMBER" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com