MEDICARE: GEORGIY ROYKHMAN MS

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	103K00000X	Behavior Analyst	1-19-39127	CA

General Provider Information

NPI Number	:	1366077109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIY ROYKHMAN MS

Provider Business Mailing Address
First Line	:	10824 BLOOMFIELD ST APT 206
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-3917
Country	:	US
Telephone Number	:	818-434-6416
Fax Number	:

Provider Business Practice Location Address
First Line	:	10824 BLOOMFIELD ST APT 206
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-3917
Country	:	US
Telephone Number	:	818-434-6416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2020
Last Update Date	:	03/11/2020

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