Individual
SUBIR ROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1520 SAN PABLO ST, LOS ANGELES, CA 90033
(323) 865-3979
(323) 265-0062
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031
(323) 221-3270
(323) 225-6284
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
A24383
CA
207VG0400X
Gynecology Physician
Primary
A24383
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A243830
BLUE SHIELD
CA
05
—
00A243830
—
CA
01
—
1992740450
GROUP NPI
—
01
—
A24383
STATE LICENSE
CA
Enumeration date
08/03/2006
Last updated
12/06/2007
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