| Robert A. Devereaux, M.d., Inc. | |
|
11100 Warner Ave Suite 100 Fountain Valley CA 92708-7506 | |
| (714) 957-9389 | |
| (714) 957-0144 |
| Full Name | Robert A. Devereaux, M.d., Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 11100 Warner Ave, Fountain Valley, California |
| Authorized Official Name and Position | Robert Allan Devereaux (PRESIDENT) |
| Authorized Official Contact | 7149579389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert A. Devereaux, M.d., Inc. 11100 Warner Ave Suite 100 Fountain Valley CA 92708-7506 Ph: (714) 957-9389 | Robert A. Devereaux, M.d., Inc. 11100 Warner Ave Suite 100 Fountain Valley CA 92708-7506 Ph: (714) 957-9389 |
| NPI Number | 1538344189 |
|---|---|
| Provider Enumeration Date | 01/02/2008 |
| Last Update Date | 02/06/2008 |
| Medicare PECOS PAC ID | 1951462290 |
|---|---|
| Medicare Enrollment ID | O20081205000204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538344189 | NPI | - | NPPES |
| 00A314750 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A31475 (California) | Primary |
| Provider Name | Robert A Devereaux |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043264781 PECOS PAC ID: 1153482484 Enrollment ID: I20081205000174 |
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