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General NPI Number Information
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NPI Number | 1366131591
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Entity Type | Individual
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Provider Name | NATHALIE MARIE DE VERA PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 113 WATERWORKS WAY
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City | IRVINE
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State | CA
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Zip | 92618-3167
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Country | US
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Telephone | 949-551-1113
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 N BROADWAY
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City | SANTA ANA
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State | CA
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Zip | 92701-3411
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Country | US
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Telephone | 714-767-6182
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA63686
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License Number State | CA
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