Provider Demographics
NPI:1114095726
Name:DEVERA, EMMANUEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:L
Last Name:DEVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 ATLANTIC AVE STE 818
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3410
Mailing Address - Country:US
Mailing Address - Phone:562-436-8117
Mailing Address - Fax:562-432-2777
Practice Address - Street 1:1045 ATLANTIC AVE STE 818
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3410
Practice Address - Country:US
Practice Address - Phone:562-436-8117
Practice Address - Fax:562-432-2777
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41773173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine