Provider Demographics
NPI:1588679997
Name:ROYALTY RADIATION ONCOLOGY MEDICAL GROUP INC.
Entity type:Organization
Organization Name:ROYALTY RADIATION ONCOLOGY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SRI
Authorized Official - Middle Name:G
Authorized Official - Last Name:GORTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-865-9890
Mailing Address - Street 1:PO BOX 844527
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-4527
Mailing Address - Country:US
Mailing Address - Phone:909-865-9890
Mailing Address - Fax:909-469-2140
Practice Address - Street 1:1910 ROYALTY DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3021
Practice Address - Country:US
Practice Address - Phone:909-865-9890
Practice Address - Fax:909-865-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098270Medicaid
HW16590Medicare ID - Type Unspecified