Provider Demographics
NPI:1932291473
Name:DEVILLE, MATHEW JAMES (DC, PA-C)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:JAMES
Last Name:DEVILLE
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2309
Mailing Address - Country:US
Mailing Address - Phone:310-722-4504
Mailing Address - Fax:
Practice Address - Street 1:2004 NELSON AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2309
Practice Address - Country:US
Practice Address - Phone:310-722-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29908111N00000X
CAPA65796363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB257136Medicare PIN