Provider Demographics
NPI:1659039436
Name:ROYAM MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:ROYAM MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:PADRON CORRALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-417-8121
Mailing Address - Street 1:1836 SIERRA VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3040
Mailing Address - Country:US
Mailing Address - Phone:702-417-8121
Mailing Address - Fax:
Practice Address - Street 1:2621 W CHARLESTON BLVD STE G
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8910
Practice Address - Country:US
Practice Address - Phone:702-417-8121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty