Joan Devito, R.D.,C.D.E.
Individual provider Active NPI Registered Dietitian · Lakeport, CA
NPI 1962549469 · NPPES record last updated Aug 1, 2025
Key facts
- NPI
- 1962549469
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- Practice address
- 925 Bevins CT
Lakeport, CA 95453-9754 - Phone
- (707) 263-8382
- Fax
- (707) 263-5019
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 1977
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Lake County Tribal Health Consortium Inc
Practice addresses (Care Compare)
925 Bevins CT
Lakeport, CA 95453-9754
Phone 70726383821204
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091104000406 | CA | Practitioner - Registered Dietitian Or Nutrition Professional | 5597803973 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake County Tribal Health Southshore Clinic | Current |
Accepting new patients | |
| Lake County Tribal Health Consortium Inc. | Current |
Accepting new patients |
Locations
14440 Olympic Dr
Clearlake, CA 95422
Phone (707) 263-8382
925 Bevins Ct
Lakeport, CA 95453
Phone (707) 263-8382
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Yes |
Addresses
Primary practice location
925 Bevins CT
Lakeport, CA 95453-9754
Mailing address
925 Bevins CT
Lakeport, CA 95453-9754
Phone (707) 263-8382
Other practice location 1
14440 Olympic Dr
Clearlake, CA 95422-8809
Phone (707) 263-8382
Other providers in Lakeport, CA
- David L. Browning OD
- Amy Sue Dawson
- Samantha Dean
- Bruce David Deas
- Alma Olga Delgado
- Richard Allan Diwald
- Tracey Michelle Dobusch
- Elyse Midori Donald
- Keith Phillip Donald
- Jonathan Michael Drew
All providers in Lakeport, CA · Registered Dietitian in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.