Healthcare Provider Details

I. General information

NPI: 1174283873
Provider Name (Legal Business Name): ALEXANDER DEMETRIUS ROYSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GRAMERCY AVE
TORRANCE CA
90501-3236
US

IV. Provider business mailing address

2790 SKYPARK DR STE 116
TORRANCE CA
90505-5320
US

V. Phone/Fax

Practice location:
  • Phone: 714-258-7710
  • Fax:
Mailing address:
  • Phone: 424-233-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: