Healthcare Provider Details

I. General information

NPI: 1053235424
Provider Name (Legal Business Name): DEVINA JEWELL EIDSON PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 WINONA WAY
NORTH HIGHLANDS CA
95660-5523
US

IV. Provider business mailing address

7223 LEE DEFOREST DR
COLUMBIA MD
21046-3236
US

V. Phone/Fax

Practice location:
  • Phone: 916-566-1600
  • Fax:
Mailing address:
  • Phone: 813-829-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220163340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: