Provider Demographics
NPI:1477338200
Name:LI, ROY
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:LI
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 1:414 S 2ND ST APT C
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3769
Mailing Address - Country:US
Mailing Address - Phone:626-551-7430
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE UNIT 20
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8840
Practice Address - Country:US
Practice Address - Phone:626-249-3838
Practice Address - Fax:855-838-9042
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician