MEDICARE: JAMES ROYSTON RN

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	163WD1100X	Peritoneal Dialysis Registered Nurse	95043868	CA

General Provider Information

NPI Number	:	1548847866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ROYSTON RN

Provider Business Mailing Address
First Line	:	14315 VIA VENEZIA APT 3206
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-1686
Country	:	US
Telephone Number	:	619-313-3472
Fax Number	:

Provider Business Practice Location Address
First Line	:	14315 VIA VENEZIA APT 3206
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-1686
Country	:	US
Telephone Number	:	619-313-3472
Fax Number	:

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

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	03/24/2021

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