Basic Information
| Provider Information | |||||||||
| NPI: | 1679700488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DROR | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12669 ENCINITAS AVE | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913423635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007008705 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12669 ENCINITAS AVE | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913423635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007008705 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 78349 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.