Provider Demographics
NPI:1245294644
Name:ROYALTY NEPHROLOGY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:ROYALTY NEPHROLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAPPOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-623-1561
Mailing Address - Street 1:1900 ROYALTY DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3032
Mailing Address - Country:US
Mailing Address - Phone:909-623-1561
Mailing Address - Fax:909-629-1418
Practice Address - Street 1:1900 ROYALTY DR
Practice Address - Street 2:SUITE 130
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3032
Practice Address - Country:US
Practice Address - Phone:909-623-1561
Practice Address - Fax:909-629-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC04254Medicare UPIN