Provider Demographics
NPI:1497040919
Name:DEBORSHI ROY MD INC
Entity type:Organization
Organization Name:DEBORSHI ROY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-738-8217
Mailing Address - Street 1:PO BOX 77365
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0112
Mailing Address - Country:US
Mailing Address - Phone:951-738-8217
Mailing Address - Fax:951-738-0524
Practice Address - Street 1:8906 SAN BERNARDINO RD
Practice Address - Street 2:SUITE104
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8805
Practice Address - Country:US
Practice Address - Phone:909-466-0847
Practice Address - Fax:909-466-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54320207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty