Provider Demographics
NPI:1871191163
Name:DEVIRGILIO, KAZUKO (LAC)
Entity Type:Individual
Prefix:
First Name:KAZUKO
Middle Name:
Last Name:DEVIRGILIO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 MAPLECREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-7965
Mailing Address - Country:US
Mailing Address - Phone:512-507-2854
Mailing Address - Fax:
Practice Address - Street 1:10601 PECAN PARK BLVD STE 302
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1448
Practice Address - Country:US
Practice Address - Phone:512-507-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01977171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist