Provider Demographics
NPI:1730335290
Name:ROYAL- REALIZING OUR YOUTH AS LEADERS INC
Entity type:Organization
Organization Name:ROYAL- REALIZING OUR YOUTH AS LEADERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE VERA
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-643-7117
Mailing Address - Street 1:2675 FOLSOM STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-643-7117
Mailing Address - Fax:415-643-7118
Practice Address - Street 1:2675 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3325
Practice Address - Country:US
Practice Address - Phone:415-643-7117
Practice Address - Fax:415-643-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health