Provider Demographics
NPI:1073823027
Name:ODDMAN, DEVAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:
Last Name:ODDMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEVAN
Other - Middle Name:
Other - Last Name:WEIDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8765 AERO DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1767
Mailing Address - Country:US
Mailing Address - Phone:858-541-0181
Mailing Address - Fax:
Practice Address - Street 1:8765 AERO DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1781
Practice Address - Country:US
Practice Address - Phone:858-541-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner