Healthcare Provider Details

I. General information

NPI: 1427357201
Provider Name (Legal Business Name): DEVETTE LEFLORE RN, PHN CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 03/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24085 AMADOR ST STE 110
HAYWARD CA
94544-1278
US

IV. Provider business mailing address

24085 AMADOR ST STE 110
HAYWARD CA
94544-1278
US

V. Phone/Fax

Practice location:
  • Phone: 510-670-8452
  • Fax: 510-670-8466
Mailing address:
  • Phone: 510-670-8452
  • Fax: 510-670-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number756031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: