MEDICARE: DR. LYDIA A. ROYBAL-ARAGON MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	G56168	CA

General Provider Information

NPI Number	:	1588712566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYDIA A. ROYBAL-ARAGON MD

Provider Business Mailing Address
First Line	:	1943 COUNTRY CLUB DR
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-7305
Country	:	US
Telephone Number	:	909-534-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 W HOSPITALITY LN
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3243
Country	:	US
Telephone Number	:	909-534-5960
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	12/16/2016

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