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General NPI Number Information
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NPI Number | 1558461327
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Entity Type | Individual
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Provider Name | AUDRA DEVEIKIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 2801 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-1701
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Country | US
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Telephone | 562-933-8590
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Fax | 562-933-8093
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Provider Business Mailing Address
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Address Line | 1536 W 25TH ST PMB 163
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City | SAN PEDRO
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State | CA
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Zip | 90732-4455
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Country | US
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Telephone | 562-933-8590
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Fax | 562-933-8093
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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 | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | A40896
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License Number State | CA
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