Provider Demographics
NPI:1093804049
Name:ROYAL, EDDIE LEONARDE SR
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:LEONARDE
Last Name:ROYAL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 E 97TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-2708
Mailing Address - Country:US
Mailing Address - Phone:310-245-1962
Mailing Address - Fax:
Practice Address - Street 1:733 HINDRY AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3005
Practice Address - Country:US
Practice Address - Phone:310-348-9850
Practice Address - Fax:310-348-8446
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10OtherSOCIAL SCIENCE TECHNICIAN