MEDICARE: LEONELLEN ROYO L.AC.

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	171100000X	Acupuncturist	8588	CA

General Provider Information

NPI Number	:	1720296924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONELLEN ROYO L.AC.

Provider Business Mailing Address
First Line	:	208 E MAPLE ST
Second Line	:	UNIT A
City	:	GLENDALE
State	:	CA
Zip	:	91205-3944
Country	:	US
Telephone Number	:	626-674-7842
Fax Number	:

Provider Business Practice Location Address
First Line	:	1727 N VERMONT AVE
Second Line	:	STE 106
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4343
Country	:	US
Telephone Number	:	323-665-8889
Fax Number	:

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

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	07/08/2007

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Directions to “ LEONELLEN ROYO L.AC.” Practice Location

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