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NPI Code Detail

MEDICARE: JENOHN TOMIKO DAVIS-GREGORY

MEDICARE: JENOHN TOMIKO DAVIS-GREGORY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician102371693SC

General Provider Information

NPI Number : 1023502648
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENOHN TOMIKO DAVIS-GREGORY
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 1239 WOODLAND DR STE 112
Second Line :
City : ELIZABETHTOWN
State : KY
Zip : 42701-3723
Country : US
Telephone Number : 502-358-5106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2018
Last Update Date : 06/18/2018

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Directions to “ JENOHN TOMIKO DAVIS-GREGORY ” Practice Location

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