Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | A40896 | CA |
NPI | 1558461327 |
---|---|
Provider Name | Dr. Audra Deveikis |
First Address | San Pedro, CA 90732-4455 |
Second Address | Long Beach, CA 90806-1701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 11/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A408960 | (05) | CA |