Healthcare Provider Details

I. General information

NPI: 1023353802
Provider Name (Legal Business Name): ANNA ROYSMAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 JAMESON CT STE 3 & 4
CARMICHAEL CA
95608-0880
US

IV. Provider business mailing address

5800 JAMESON CT STE 3 & 4
CARMICHAEL CA
95608-0880
US

V. Phone/Fax

Practice location:
  • Phone: 916-847-6804
  • Fax:
Mailing address:
  • Phone: 916-847-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA56391
License Number StateCA

VIII. Authorized Official

Name: ANNA ROYSMAN
Title or Position: MD
Credential:
Phone: 916-847-6804