Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2286241 | NY |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | C54320 | CA |
NPI | 1184744336 |
---|---|
Provider Name | Dr. Deborshi Roy |
First Address | Corona, CA 92877-0112 |
Second Address | Rancho Cucamonga, CA 91730-0713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 26/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
228624 | LICENSE (01) | NY |
H99825 | (02) | NY |