Healthcare Provider Details

I. General information

NPI: 1932291473
Provider Name (Legal Business Name): MATHEW JAMES DEVILLE D.C., PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 NELSON AVE
REDONDO BEACH CA
90278-2309
US

IV. Provider business mailing address

2004 NELSON AVE
REDONDO BEACH CA
90278-2309
US

V. Phone/Fax

Practice location:
  • Phone: 310-722-4504
  • Fax:
Mailing address:
  • Phone: 310-722-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65796
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: