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NPI Code Detail

MEDICARE: JAKE CHRISTIAN DAVIS

MEDICARE: JAKE CHRISTIAN 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
1101YA0400XAddiction (Substance Use Disorder) CounselorR1625540725CA

General Provider Information

NPI Number : 1396691812
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAKE CHRISTIAN DAVIS
Provider Business Mailing Address
First Line : 308 BANBRIDGE AVE
Second Line :
City : LA PUENTE
State : CA
Zip : 91744-4806
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11682 ATLANTIC AVE
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-3832
Country : US
Telephone Number : 626-501-2531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/06/2026

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