Provider Demographics
NPI:1740062785
Name:LEYOU, ROGER
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:LEYOU
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 1:3022 JAVIER RD STE 152
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4624
Mailing Address - Country:US
Mailing Address - Phone:202-258-3344
Mailing Address - Fax:571-475-9528
Practice Address - Street 1:3022 JAVIER RD STE 152
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4624
Practice Address - Country:US
Practice Address - Phone:202-258-3344
Practice Address - Fax:571-475-9528
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-00051403747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant