Provider Demographics
NPI:1053022319
Name:PRESLEY, DEAN ALEXANDER (CA LICENSE NO L9737)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:ALEXANDER
Last Name:PRESLEY
Suffix:
Gender:M
Credentials:CA LICENSE NO L9737
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:M
Other - Last Name:PRESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:384 JACKSON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1556
Mailing Address - Country:US
Mailing Address - Phone:415-209-8698
Mailing Address - Fax:
Practice Address - Street 1:384 JACKSON ST STE 3
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1556
Practice Address - Country:US
Practice Address - Phone:415-209-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist