Active NPI
Jesse R. Devera, M.D.
- Psychiatry Physician
- San Bernardino, CA
National Provider Identifier
1023159118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A41881
- Practice address
- 303 E Vanderbilt Way
San Bernardino, CA 92415-0026 - Phone
- (909) 388-0810
- Fax
- (909) 890-2081
- NPI assigned
- Feb 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A41881 | CA | |
| Psychiatry Physician | 2084P0800X | A41881 | CA | Primary |
Addresses
Primary practice location
303 E Vanderbilt Way
San Bernardino, CA 92415-0026
Mailing address
303 E Vanderbilt Way
San Bernardino, CA 92415-0026
Phone (909) 388-0810
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A41881 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483574400000",
"number": "1023159118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303 E VANDERBILT WAY",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924150026",
"telephone_number": "909-388-0810",
"fax_number": "909-890-2081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 E VANDERBILT WAY",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924150026",
"telephone_number": "909-388-0810",
"fax_number": "909-890-2081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVERA",
"first_name": "JESSE",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2017-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A41881",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A41881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.