Provider Demographics
NPI:1750649190
Name:ROYBAL, ELENA
Entity Type:Individual
Prefix:MISS
First Name:ELENA
Middle Name:
Last Name:ROYBAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2716
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-4716
Mailing Address - Country:US
Mailing Address - Phone:505-692-9527
Mailing Address - Fax:
Practice Address - Street 1:1206 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2811
Practice Address - Country:US
Practice Address - Phone:505-747-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator