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NPI Code Detail

MEDICARE: MYRA DEVORE M.A.

MEDICARE: MYRA DEVORE M.A.
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1588702138
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRA DEVORE M.A.
Provider Business Mailing Address
First Line : 1001 POLK ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94109-6915
Country : US
Telephone Number : 415-292-2108
Fax Number :
Provider Business Practice Location Address
First Line : 1001 POLK ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94109-6915
Country : US
Telephone Number : 415-292-2108
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2007
Last Update Date : 07/08/2007

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