Provider Demographics
NPI:1982219812
Name:DEVANEY, MONICA MITCHEL (RD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MITCHEL
Last Name:DEVANEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-1604
Mailing Address - Country:US
Mailing Address - Phone:209-658-7751
Mailing Address - Fax:
Practice Address - Street 1:7875 BLUE MOON RD
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-6346
Practice Address - Country:US
Practice Address - Phone:209-658-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered