Healthcare Provider Details

I. General information

NPI: 1285679779
Provider Name (Legal Business Name): LEON DENSON ROYSTON JR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 FRANKLIN ST
CHICO CA
95928-6727
US

IV. Provider business mailing address

2012 FRANKLIN ST
CHICO CA
95928-6727
US

V. Phone/Fax

Practice location:
  • Phone: 530-899-4791
  • Fax: 530-893-6184
Mailing address:
  • Phone: 530-899-4791
  • Fax: 530-893-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA12790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: