Healthcare Provider Details

I. General information

NPI: 1437147022
Provider Name (Legal Business Name): ROYAL TERRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2005
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 HIGHLAND AVE
DUARTE CA
91010-2520
US

IV. Provider business mailing address

1340 HIGHLAND AVE
DUARTE CA
91010-2520
US

V. Phone/Fax

Practice location:
  • Phone: 626-256-4654
  • Fax: 626-256-9354
Mailing address:
  • Phone: 626-256-4654
  • Fax: 626-256-9354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LYDIA FLORO CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 323-965-0600