MEDICARE: ROYAL HEALTH ACT, INC.

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	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477225928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL HEALTH ACT, INC.

Provider Business Mailing Address
First Line	:	3415 W 100TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-2103
Country	:	US
Telephone Number	:	786-203-3794
Fax Number	:

Provider Business Practice Location Address
First Line	:	3415 W 100TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-2103
Country	:	US
Telephone Number	:	786-203-3794
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAY DIAZ
Credential	:	APRN
Telephone Number	:	786-203-3794

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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