Provider Demographics
NPI:1457017618
Name:ROYER, TIMOTHY
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ROYER
Suffix:
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 1:60525 YUCCA RD # 264
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92561-3745
Mailing Address - Country:US
Mailing Address - Phone:760-832-0301
Mailing Address - Fax:
Practice Address - Street 1:50 ALESSANDRO PL STE 410
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3175
Practice Address - Country:US
Practice Address - Phone:626-793-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily