MEDICARE: ROYBAL FAMILY MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1336220060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYBAL FAMILY MENTAL HEALTH

Provider Business Mailing Address
First Line	:	17101 E FRANCISQUITO AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-3830
Country	:	US
Telephone Number	:	626-917-2328
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 E CESAR E CHAVEZ AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1209
Country	:	US
Telephone Number	:	323-267-3400
Fax Number	:

Authorized Official
Title or Position	:	SR. COMMUNITY WORKER II
Name	:	MRS. IDA CECELIA MUNOZ
Credential	:
Telephone Number	:	323-267-3400

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/18/2008

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Directions to “ROYBAL FAMILY MENTAL HEALTH ” Practice Location

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