1801921952 NPI number — ROY MEDICAL GROUP, INC.

Table of content: (NPI 1801921952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801921952 NPI number — ROY MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROY MEDICAL GROUP, INC.
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:
1801921952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21001 SHERMAN WAY
Provider Second Line Business Mailing Address:
STE. 15
Provider Business Mailing Address City Name:
CANOGA PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91303-1760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-716-0048
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21001 SHERMAN WAY
Provider Second Line Business Practice Location Address:
STE. 15
Provider Business Practice Location Address City Name:
CANOGA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91303-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-716-0048
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROY
Authorized Official First Name:
ROSALINDA
Authorized Official Middle Name:
AMOR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-554-5018

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C42697 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208D00000X , with the licence number: C42697 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 00C041801 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00C426970 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0076970 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0076971 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A882980 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A522370 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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