Basic Information
| Provider Information | |||||||||
| NPI: | 1568490639 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROYCE L. HUTAIN, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 N CORNELL AVE | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928312744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149922730 | ||||||||
| FaxNumber: | 7149921918 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N CORNELL AVE | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928312744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149922730 | ||||||||
| FaxNumber: | 7149921918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 02/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUTAIN | ||||||||
| AuthorizedOfficialFirstName: | ROYCE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7149922730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G35907 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8413039 | 05 | CA | MEDICAID |