Provider Demographics
NPI:1629651054
Name:ROYAL, DELANO KENYATTA
Entity Type:Individual
Prefix:
First Name:DELANO
Middle Name:KENYATTA
Last Name:ROYAL
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 1:41496 ROYAL DORNOCH CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-2057
Mailing Address - Country:US
Mailing Address - Phone:949-630-8964
Mailing Address - Fax:
Practice Address - Street 1:41496 ROYAL DORNOCH CT
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-2057
Practice Address - Country:US
Practice Address - Phone:949-630-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date: