Healthcare Provider Details

I. General information

NPI: 1336943612
Provider Name (Legal Business Name): DEON TIMOTHY PAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 B ST
HAYWARD CA
94541-3017
US

IV. Provider business mailing address

285 LARISSA LN
VALLEJO CA
94590-7601
US

V. Phone/Fax

Practice location:
  • Phone: 510-963-9849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: