| Roy Medical Group, Inc. | |
|
21001 Sherman Way Ste. 15 Canoga Park CA 91303-1760 | |
| (818) 716-0048 | |
| Not Available |
| Full Name | Roy Medical Group, Inc. |
|---|---|
| Speciality | General Practice |
| Location | 21001 Sherman Way, Canoga Park, California |
| Authorized Official Name and Position | Rosalinda Amor Roy (PRESIDENT) |
| Authorized Official Contact | 8185545018 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roy Medical Group, Inc. 21001 Sherman Way Ste. 15 Canoga Park CA 91303-1760 Ph: (818) 716-0048 | Roy Medical Group, Inc. 21001 Sherman Way Ste. 15 Canoga Park CA 91303-1760 Ph: (818) 716-0048 |
| NPI Number | 1801921952 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1658682729 |
|---|---|
| Medicare Enrollment ID | O20150616000836 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801921952 | NPI | - | NPPES |
| 00C041801 | Medicaid | CA | |
| 00C426970 | Medicaid | CA | |
| GR0076970 | Medicaid | CA | |
| GR0076971 | Medicaid | CA | |
| 00A882980 | Medicaid | CA | |
| 00A522370 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C42697 (California) | Primary |
| 208D00000X | General Practice | C42697 (California) | Primary |
| Provider Name | Adelaida B Antonio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134337975 PECOS PAC ID: 5890777536 Enrollment ID: I20040604000906 |
| Provider Name | Iraj Shamsa |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1871655654 PECOS PAC ID: 2466648399 Enrollment ID: I20101118000126 |
| Provider Name | Mohammad Sirajullah |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1346339884 PECOS PAC ID: 9931173994 Enrollment ID: I20150620000057 |
| Provider Name | Rosalinda Amor Roy |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821021981 PECOS PAC ID: 3375574528 Enrollment ID: I20160411001494 |
| Provider Name | Susan Yanira Aquino Cobar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194463281 PECOS PAC ID: 4183096555 Enrollment ID: I20230213000094 |
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