Provider Demographics
NPI:1205839735
Name:ANUNCIACION, ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:ANUNCIACION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 TIENDA DR
Mailing Address - Street 2:STE 102
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1920 TIENDA DR
Practice Address - Street 2:STE 102
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3930
Practice Address - Country:US
Practice Address - Phone:209-368-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74550208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A745501Medicare ID - Type Unspecified
CAH55956Medicare UPIN