Provider Demographics
NPI:1659383636
Name:DEVAUL, KATHERINE RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:RUSSELL
Last Name:DEVAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:683 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-1942
Mailing Address - Country:US
Mailing Address - Phone:650-796-1221
Mailing Address - Fax:
Practice Address - Street 1:550 HAMILTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2010
Practice Address - Country:US
Practice Address - Phone:650-279-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1096022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC25096UMedicare UPIN