Provider Demographics
NPI:1205448024
Name:ROYBAL, RICHARD
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:ROYBAL
Suffix:
Gender:M
Credentials:
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 2842
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-2842
Mailing Address - Country:US
Mailing Address - Phone:707-407-9167
Mailing Address - Fax:
Practice Address - Street 1:4514 VALLEY WEST BLVD APT A
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4685
Practice Address - Country:US
Practice Address - Phone:707-407-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB4707618172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver