Provider Demographics
NPI:1154392421
Name:DEVEREAUX, ASHA VYAS (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ASHA
Middle Name:VYAS
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 10TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3420
Mailing Address - Country:US
Mailing Address - Phone:619-435-4203
Mailing Address - Fax:619-435-0594
Practice Address - Street 1:1224 10TH ST STE 205
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118
Practice Address - Country:US
Practice Address - Phone:619-435-4203
Practice Address - Fax:619-435-0594
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 51614207R00000X, 207RC0200X
CACA51614207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A516140Medicaid
CA500201Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAH80388Medicare UPIN