Healthcare Provider Details

I. General information

NPI: 1558580969
Provider Name (Legal Business Name): ROY K MARUBAYASHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 VACA VALLEY PKWY
VACAVILLE CA
95688-9430
US

IV. Provider business mailing address

28017 STATE HIGHWAY 128
WINTERS CA
95694-9067
US

V. Phone/Fax

Practice location:
  • Phone: 510-625-6262
  • Fax:
Mailing address:
  • Phone: 707-453-5419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG52485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: