Healthcare Provider Details

I. General information

NPI: 1174909063
Provider Name (Legal Business Name): DONALD ROYSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 05/13/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

2615 S MILLER ST STE 106
SANTA MARIA CA
93455-1775
US

V. Phone/Fax

Practice location:
  • Phone: 805-366-4040
  • Fax: 805-987-7237
Mailing address:
  • Phone: 805-319-7502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: