Provider Demographics
NPI:1700486396
Name:RANTUNG, ROYKE
Entity Type:Individual
Prefix:
First Name:ROYKE
Middle Name:
Last Name:RANTUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROY
Other - Middle Name:
Other - Last Name:RANTUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22431 TERRACE PINES DR APT D
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22431 TERRACE PINES DR APT D
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5059
Practice Address - Country:US
Practice Address - Phone:909-572-0472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95230241163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse