Healthcare Provider Details

I. General information

NPI: 1598180341
Provider Name (Legal Business Name): NETA DUVDEVANY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date: 05/25/2021
Reactivation Date: 07/12/2021

III. Provider practice location address

5168 HONPIE RD
PLACERVILLE CA
95667-8682
US

IV. Provider business mailing address

2800 N CALIFORNIA ST STE 14
STOCKTON CA
95204-3759
US

V. Phone/Fax

Practice location:
  • Phone: 530-387-4975
  • Fax:
Mailing address:
  • Phone: 209-464-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16474
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC137556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: