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NPI Code Detail

MEDICARE: KANISHA DAVIS LVN

MEDICARE: KANISHA DAVIS LVN
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
1164X00000XLicensed Vocational Nurse251368CA

General Provider Information

NPI Number : 1720631468
Entity Type Code : Individual
Provider Name (Legal Business Name) : KANISHA DAVIS LVN
Provider Business Mailing Address
First Line : 9124 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-3518
Country : US
Telephone Number : 909-676-2348
Fax Number :
Provider Business Practice Location Address
First Line : 9124 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-3518
Country : US
Telephone Number : 909-676-2348
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2019
Last Update Date : 07/22/2019

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