Provider Demographics
NPI:1871777243
Name:ROY, PRISCILLIA (MD)
Entity type:Individual
Prefix:
First Name:PRISCILLIA
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:PO BOX 41516
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90853-1516
Mailing Address - Country:US
Mailing Address - Phone:562-285-5050
Mailing Address - Fax:562-285-5055
Practice Address - Street 1:555 E OCEAN BLVD
Practice Address - Street 2:STE 110
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5003
Practice Address - Country:US
Practice Address - Phone:562-285-5050
Practice Address - Fax:562-285-5055
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871777243OtherNPI