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General NPI Number Information
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NPI Number | 1497040919
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Entity Type | Organization
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Legal Business Name | DEBORSHI ROY MD INC
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 8906 SAN BERNARDINO RD SUITE104
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8805
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Country | US
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Telephone | 909-466-0847
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Fax | 909-466-0867
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Provider Business Mailing Address
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Address Line | PO BOX 77365
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City | CORONA
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State | CA
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Zip | 92877-0112
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Country | US
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Telephone | 951-738-8217
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Fax | 951-738-0524
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KIMBERLY DIANE SWANSON
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Credential |
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Telephone | 951-738-8217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | C54320
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License Number State | CA
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