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NPI Code Detail

MEDICARE: MAURA DEVEREUX PA-C

MEDICARE:   MAURA  DEVEREUX  PA-C
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
1363A00000XPhysician AssistantPA20220CA

General Provider Information

NPI Number : 1255562724
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAURA DEVEREUX PA-C
Provider Business Mailing Address
First Line : 45 CASTRO ST STE 125
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94114-1032
Country : US
Telephone Number : 415-621-4369
Fax Number :
Provider Business Practice Location Address
First Line : 45 CASTRO ST STE 125
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94114-1032
Country : US
Telephone Number : 415-621-4369
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2009
Last Update Date : 12/14/2010

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Directions to “ MAURA DEVEREUX PA-C” Practice Location

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