=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508026550
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROY EGARI M.D. MEDICAL CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2008
-----------------------------------------------------
Last Update Date | 08/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18011 PIONEER BLVD
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90701-3904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-402-0711
-----------------------------------------------------
Fax | 562-402-4338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18011 PIONEER BLVD
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90701-3904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-402-0711
-----------------------------------------------------
Fax | 562-402-4338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROY EGARI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 562-402-0711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | A37407
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------