Provider Demographics
NPI:1992495436
Name:DEVINO, JOHANNES
Entity type:Individual
Prefix:
First Name:JOHANNES
Middle Name:
Last Name:DEVINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2381 CIPRIANO LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1006
Mailing Address - Country:US
Mailing Address - Phone:208-585-1303
Mailing Address - Fax:
Practice Address - Street 1:2381 CIPRIANO LN
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1006
Practice Address - Country:US
Practice Address - Phone:208-585-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist