Provider Demographics
NPI:1376628560
Name:ROYBAL FAMILY MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:ROYBAL FAMILY MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-722-7262
Mailing Address - Street 1:2602 E FLORENCE AVE # 273
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4708
Mailing Address - Country:US
Mailing Address - Phone:323-855-2724
Mailing Address - Fax:
Practice Address - Street 1:2602 E FLORENCE AVE # 273
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4708
Practice Address - Country:US
Practice Address - Phone:323-855-2724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN/A251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management