Provider Demographics
NPI:1801921952
Name:ROY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:ROY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:AMOR
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-554-5018
Mailing Address - Street 1:21001 SHERMAN WAY
Mailing Address - Street 2:STE. 15
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1760
Mailing Address - Country:US
Mailing Address - Phone:818-716-0048
Mailing Address - Fax:
Practice Address - Street 1:21001 SHERMAN WAY
Practice Address - Street 2:STE. 15
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1760
Practice Address - Country:US
Practice Address - Phone:818-716-0048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42697207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C041801Medicaid
CA00C426970Medicaid
CAGR0076970Medicaid
CAGR0076971Medicaid
CA00A882980Medicaid
CA00A522370Medicaid
CA=========OtherTAX ID