MEDICARE: KIARRA DAVIS

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
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1033827027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARRA DAVIS

Provider Business Mailing Address
First Line	:	1322 W 60TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-2828
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 W 60TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-2828
Country	:	US
Telephone Number	:	323-925-9541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/09/2022

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Directions to “ KIARRA DAVIS ” Practice Location

Language	Start Address	Practice Location

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