Healthcare Provider Details

I. General information

NPI: 1912089913
Provider Name (Legal Business Name): CASSONDRA ELIZABETH DAVIS MC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SCHOOL DR
HUACHUCA CITY AZ
85616
US

IV. Provider business mailing address

1041 OCOTILLO DR
SIERRA VISTA AZ
85635
US

V. Phone/Fax

Practice location:
  • Phone: 520-456-9842
  • Fax: 520-456-9811
Mailing address:
  • Phone: 520-458-3254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: