Provider Demographics
NPI:1336444371
Name:DEVESA, JOSE ANDRES (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANDRES
Last Name:DEVESA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 N MIRAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3054
Mailing Address - Country:US
Mailing Address - Phone:352-538-9768
Mailing Address - Fax:
Practice Address - Street 1:878 N MIRAMAR AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3054
Practice Address - Country:US
Practice Address - Phone:321-676-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10213111N00000X
246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No111N00000XChiropractic ProvidersChiropractor