Provider Demographics
NPI:1598180341
Name:DUVDEVANY, NETA
Entity Type:Individual
Prefix:
First Name:NETA
Middle Name:
Last Name:DUVDEVANY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N CALIFORNIA ST STE 14
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3759
Mailing Address - Country:US
Mailing Address - Phone:209-464-2605
Mailing Address - Fax:
Practice Address - Street 1:5168 HONPIE RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8682
Practice Address - Country:US
Practice Address - Phone:530-387-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2023-09-20
Deactivation Date:2021-05-25
Deactivation Code:
Reactivation Date:2021-07-12
Provider Licenses
StateLicense IDTaxonomies
NH16474208000000X
CAC137556208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics