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NPI Code Detail

MEDICARE: JENNIFER LISE DAVIS MD

MEDICARE: JENNIFER LISE DAVIS MD
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
1208D00000XGeneral Practice PhysicianA101027CA

General Provider Information

NPI Number : 1720175862
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LISE DAVIS MD
Provider Business Mailing Address
First Line : 3160 CAMINO DEL RIO S STE 315
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3835
Country : US
Telephone Number : 619-377-9909
Fax Number : 619-378-6596
Provider Business Practice Location Address
First Line : 3160 CAMINO DEL RIO S STE 315
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3835
Country : US
Telephone Number : 619-377-9909
Fax Number : 619-378-6596
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2006
Last Update Date : 04/17/2024

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Directions to “ JENNIFER LISE DAVIS MD” Practice Location

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