=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245292994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARIS E. ROYO MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 10/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 H ST SUITE 4
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-5834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-743-1873
-----------------------------------------------------
Fax | 530-743-0427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 H ST SUITE 4
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-5834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-743-1873
-----------------------------------------------------
Fax | 530-743-0427
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECT OWNER
-----------------------------------------------------
Name | DR. PARIS E ROYO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 530-743-4453
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | C26467
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------