Provider Demographics
NPI:1871603829
Name:EGARI, ROY (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:EGARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18011 PIONEER BLVD.
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701
Mailing Address - Country:US
Mailing Address - Phone:564-402-0711
Mailing Address - Fax:562-402-4338
Practice Address - Street 1:18011 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3904
Practice Address - Country:US
Practice Address - Phone:564-402-0711
Practice Address - Fax:562-402-4338
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37407261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0019310Medicaid
AR330065892OtherTAX ID
CAGR0019310Medicaid