Provider Demographics
NPI:1578180618
Name:DEVAGUDI, DEEPTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPTHI
Middle Name:
Last Name:DEVAGUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 W ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3183
Mailing Address - Country:US
Mailing Address - Phone:714-827-3000
Mailing Address - Fax:
Practice Address - Street 1:3033 W ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3156
Practice Address - Country:US
Practice Address - Phone:714-827-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA186617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine