Provider Demographics
NPI:1306900832
Name:ROY, RITA (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5018
Mailing Address - Country:US
Mailing Address - Phone:562-622-1100
Mailing Address - Fax:562-622-3300
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5018
Practice Address - Country:US
Practice Address - Phone:562-622-1100
Practice Address - Fax:562-622-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA31632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A316320OtherMEDI-CAL