Healthcare Provider Details

I. General information

NPI: 1013078781
Provider Name (Legal Business Name): ANITA M ROYBAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GOLF COURSE RD SE SUITE 201
RIO RANCHO NM
87124-4731
US

IV. Provider business mailing address

1101 GOLF COURSE RD SE SUITE 201
RIO RANCHO NM
87124-4731
US

V. Phone/Fax

Practice location:
  • Phone: 505-234-1612
  • Fax: 505-234-1618
Mailing address:
  • Phone: 505-234-1612
  • Fax: 505-234-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number84-110
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: