Provider Demographics
NPI:1558580969
Name:MARUBAYASHI, ROY K
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:K
Last Name:MARUBAYASHI
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 1:28017 STATE HIGHWAY 128
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-9067
Mailing Address - Country:US
Mailing Address - Phone:707-453-5419
Mailing Address - Fax:
Practice Address - Street 1:3700 VACA VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9430
Practice Address - Country:US
Practice Address - Phone:510-625-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52485208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics