MEDICARE: TANAE ROYAL

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

General Provider Information

NPI Number	:	1568204774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANAE ROYAL

Provider Business Mailing Address
First Line	:	3445 SOLEDAD AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93619-8715
Country	:	US
Telephone Number	:	559-573-1323
Fax Number	:

Provider Business Practice Location Address
First Line	:	3445 SOLEDAD AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93619-8715
Country	:	US
Telephone Number	:	559-573-1323
Fax Number	:

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

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/05/2026

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Directions to “ TANAE ROYAL ” Practice Location

Language	Start Address	Practice Location

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