MEDICARE: DR. OSCAR S. DEVERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A52694	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A526940	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1205946639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSCAR S. DEVERA M.D.

Provider Business Mailing Address
First Line	:	2589 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1446
Country	:	US
Telephone Number	:	626-798-8792
Fax Number	:	626-798-9607

Provider Business Practice Location Address
First Line	:	3208 SANTA ANITA AVE
Second Line	:	200
City	:	EL MONTE
State	:	CA
Zip	:	91733-1360
Country	:	US
Telephone Number	:	626-454-1990
Fax Number	:	626-454-1995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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