Healthcare Provider Details

I. General information

NPI: 1720232945
Provider Name (Legal Business Name): ROYAL CCT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14676 DOOLITTLE DR
SAN LEANDRO CA
94577-6617
US

IV. Provider business mailing address

14676 DOOLITTLE DR
SAN LEANDRO CA
94577-6617
US

V. Phone/Fax

Practice location:
  • Phone: 510-568-6161
  • Fax: 510-568-6160
Mailing address:
  • Phone: 510-568-6161
  • Fax: 510-568-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1889
License Number StateCA

VIII. Authorized Official

Name: STEVE GRAU
Title or Position: PRESIDENT
Credential:
Phone: 510-568-6161