Healthcare Provider Details

I. General information

NPI: 1427721679
Provider Name (Legal Business Name): JULIE DEVITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 07/25/2021
Certification Date: 07/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26302 LA PAZ RD STE 201
MISSION VIEJO CA
92691-5328
US

IV. Provider business mailing address

24512 ALTA LOMA CT
LAGUNA HILLS CA
92653-6217
US

V. Phone/Fax

Practice location:
  • Phone: 949-586-9848
  • Fax:
Mailing address:
  • Phone: 949-275-8957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94025414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: