Provider Demographics
NPI:1508026550
Name:ROY EGARI M.D. MEDICAL CLINIC
Entity Type:Organization
Organization Name:ROY EGARI M.D. MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-402-0711
Mailing Address - Street 1:18011 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3904
Mailing Address - Country:US
Mailing Address - Phone:562-402-0711
Mailing Address - Fax:562-402-4338
Practice Address - Street 1:18011 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3904
Practice Address - Country:US
Practice Address - Phone:562-402-0711
Practice Address - Fax:562-402-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37407261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0019310Medicaid
CAB50352Medicare UPIN
CAW9152Medicare PIN