Provider Demographics
NPI:1104954908
Name:DE VEDIA, ANA (LAC)
Entity type:Individual
Prefix:MS
First Name:ANA
Middle Name:
Last Name:DE VEDIA
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 1:4711 VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2529
Mailing Address - Country:US
Mailing Address - Phone:619-282-3100
Mailing Address - Fax:619-282-3100
Practice Address - Street 1:4711 VISTA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2529
Practice Address - Country:US
Practice Address - Phone:619-282-3100
Practice Address - Fax:619-282-3100
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACY2648171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist