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General NPI Number Information
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NPI Number | 1053597641
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Entity Type | Organization
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Legal Business Name | ASHA DEVEREAUX, MD, MPH A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 1224 10TH ST STE 205
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City | CORONADO
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State | CA
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Zip | 92118-3416
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Country | US
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Telephone | 619-435-4203
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Fax |
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Provider Business Mailing Address
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Address Line | 1224 10TH ST STE 205
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City | CORONADO
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State | CA
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Zip | 92118-3416
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Country | US
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Telephone | 619-435-4203
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ASHA V DEVEREAUX
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Credential | MD
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Telephone | 619-435-4203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A51614
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License Number State | CA
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