Provider Demographics
NPI:1174283873
Name:ROYSTON, ALEXANDER DEMETRIUS
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DEMETRIUS
Last Name:ROYSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 SKYPARK DR STE 116
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5320
Mailing Address - Country:US
Mailing Address - Phone:424-233-5457
Mailing Address - Fax:
Practice Address - Street 1:1691 GRAMERCY AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3236
Practice Address - Country:US
Practice Address - Phone:714-258-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator