MEDICARE: RAJIV ROY CPO

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	222Z00000X	Orthotist	213000358	IL
2	224P00000X	Prosthetist	211000288	IL

General Provider Information

NPI Number	:	1952599979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJIV ROY CPO

Provider Business Mailing Address
First Line	:	1675 MESQUITE AVE STE A
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5665
Country	:	US
Telephone Number	:	928-680-4089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 MESQUITE AVE STE A
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5665
Country	:	US
Telephone Number	:	928-680-4089
Fax Number	:

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	03/12/2025

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