Provider Demographics
NPI:1285867820
Name:DEVARAJ, JOSEPHINE MEE (DO)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:MEE
Last Name:DEVARAJ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:MEE
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:507 SOUTH ATLANTIC BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022
Mailing Address - Country:US
Mailing Address - Phone:323-268-9191
Mailing Address - Fax:323-268-9119
Practice Address - Street 1:507 SOUTH ATLANTIC BOULEVARD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:559-457-5700
Practice Address - Fax:559-457-5790
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine