Provider Demographics
NPI:1073678199
Name:DEVILLY, SIMON JAMES (MA)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:JAMES
Last Name:DEVILLY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5615 WHITTIER BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4128
Mailing Address - Country:US
Mailing Address - Phone:323-721-6424
Mailing Address - Fax:323-721-1815
Practice Address - Street 1:5615 WHITTIER BLVD STE E
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-4128
Practice Address - Country:US
Practice Address - Phone:323-721-6424
Practice Address - Fax:323-721-1815
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2040237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter