Provider Demographics
NPI:1578707071
Name:ROY, PUJA (MD)
Entity Type:Individual
Prefix:
First Name:PUJA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8670 WILSHIRE BLVD
Mailing Address - Street 2:SPECIALTY SURGICAL CENTER
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2930
Mailing Address - Country:US
Mailing Address - Phone:310-275-1646
Mailing Address - Fax:310-659-2333
Practice Address - Street 1:8268 ASHWORTH CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3638
Practice Address - Country:US
Practice Address - Phone:202-320-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA134350207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program