Provider Demographics
NPI:1285337428
Name:ROYBAL, AMOR
Entity type:Individual
Prefix:
First Name:AMOR
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 1:3120 BLUME ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4949
Mailing Address - Country:US
Mailing Address - Phone:505-306-5213
Mailing Address - Fax:
Practice Address - Street 1:3120 BLUME ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-4949
Practice Address - Country:US
Practice Address - Phone:505-306-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
517933503106S00000X
NM517933503106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician