Healthcare Provider Details

I. General information

NPI: 1629651054
Provider Name (Legal Business Name): DELANO KENYATTA ROYAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41496 ROYAL DORNOCH CT
TEMECULA CA
92591-2057
US

IV. Provider business mailing address

41496 ROYAL DORNOCH CT
TEMECULA CA
92591-2057
US

V. Phone/Fax

Practice location:
  • Phone: 949-630-8964
  • Fax:
Mailing address:
  • Phone: 949-630-8964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: