Provider Demographics
NPI:1356545362
Name:DEVEGA, MARIA ROSARIO (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSARIO
Last Name:DEVEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 MONTGOMERY RD
Mailing Address - Street 2:#206
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3187
Mailing Address - Country:US
Mailing Address - Phone:513-631-0763
Mailing Address - Fax:
Practice Address - Street 1:4411 MONTGOMERY RD
Practice Address - Street 2:#206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-3187
Practice Address - Country:US
Practice Address - Phone:513-631-0763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57012138390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH57012138OtherMD TRAINING CERTIFICATE