Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | PSY5472 | CA |
NPI | 1104972306 |
---|---|
Provider Name | Dr. David Andrew Devine |
First Address | San Jose, CA 95119-1380 |
Second Address | San Jose, CA 95119-1380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2007 |
Last Update Date | 08/07/2007 |