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General NPI Number Information
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NPI Number | 1033859277
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Entity Type | Individual
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Provider Name | DEVIN VICTOR BAGEAC
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Gender | Male
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 1500 SAN PABLO ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-5313
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Country | US
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Telephone | 732-330-3975
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Fax |
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Provider Business Mailing Address
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Address Line | 73 CRANMOOR DR
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City | TOMS RIVER
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State | NJ
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Zip | 08753-6865
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Country | US
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Telephone | 732-330-3975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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