Healthcare Provider Details

I. General information

NPI: 1609792753
Provider Name (Legal Business Name): JOSEPH ROYAL SUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 3RD ST STE C
LAKE ELSINORE CA
92530-2748
US

IV. Provider business mailing address

600 3RD ST STE C
LAKE ELSINORE CA
92530-2748
US

V. Phone/Fax

Practice location:
  • Phone: 951-674-5354
  • Fax:
Mailing address:
  • Phone: 951-674-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: