Provider Demographics
NPI:1326072455
Name:DEVITO, JAMIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:R
Last Name:DEVITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:R
Other - Last Name:DEVITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-340-3911
Mailing Address - Fax:760-773-1239
Practice Address - Street 1:1080 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4869
Practice Address - Country:US
Practice Address - Phone:760-773-4280
Practice Address - Fax:760-773-4283
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68145207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55224Medicare UPIN