Provider Demographics
NPI:1639915556
Name:ALEXANDER, DAYONTE LERAY
Entity type:Individual
Prefix:
First Name:DAYONTE
Middle Name:LERAY
Last Name:ALEXANDER
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 1:4177 PAISLEYSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-6630
Mailing Address - Country:US
Mailing Address - Phone:313-808-9267
Mailing Address - Fax:
Practice Address - Street 1:4177 PAISLEYSHIRE WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-6630
Practice Address - Country:US
Practice Address - Phone:313-808-9267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW1792007172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty