Provider Demographics
NPI:1689908063
Name:DEVANICASPECIALTYCARE
Entity Type:Organization
Organization Name:DEVANICASPECIALTYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:011170
Authorized Official - Phone:813-727-1611
Mailing Address - Street 1:7513 FRAGANCIA CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2418
Mailing Address - Country:US
Mailing Address - Phone:813-727-1611
Mailing Address - Fax:813-901-8888
Practice Address - Street 1:7513 FRAGANCIA CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2418
Practice Address - Country:US
Practice Address - Phone:813-727-1611
Practice Address - Fax:813-901-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230468253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care