Provider Demographics
NPI:1093143430
Name:ROYBAL MD CHEMICAL DEPENDENCE TREATMENT INC
Entity Type:Organization
Organization Name:ROYBAL MD CHEMICAL DEPENDENCE TREATMENT INC
Other - Org Name:TRUE LIFE CENTER FOR WELLBEING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:ROYBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-202-1822
Mailing Address - Street 1:4520 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121
Mailing Address - Country:US
Mailing Address - Phone:858-202-1822
Mailing Address - Fax:858-202-4421
Practice Address - Street 1:4520 EXECUTIVE DR
Practice Address - Street 2:SUITE 225
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3018
Practice Address - Country:US
Practice Address - Phone:858-202-1822
Practice Address - Fax:858-202-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X, 101YM0800X, 103T00000X, 103TA0400X, 2084B0040X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty