Healthcare Provider Details

I. General information

NPI: 1023313772
Provider Name (Legal Business Name): ROY NATTIV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 FOX HILLS DR
LOS ANGELES CA
90025-6005
US

IV. Provider business mailing address

1760 TERMINO AVE STE 300
LONG BEACH CA
90804-2157
US

V. Phone/Fax

Practice location:
  • Phone: 310-844-1194
  • Fax: 310-844-9166
Mailing address:
  • Phone: 562-933-3009
  • Fax: 562-933-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN8431
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA116897
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA116897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: