Healthcare Provider Details

I. General information

NPI: 1881378172
Provider Name (Legal Business Name): TRISHA LYNN DAVIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 E SOUTHERN AVE STE 107
MESA AZ
85206-2790
US

IV. Provider business mailing address

5110 E SOUTHERN AVE STE 107
MESA AZ
85206-2790
US

V. Phone/Fax

Practice location:
  • Phone: 888-405-6396
  • Fax: 415-252-7176
Mailing address:
  • Phone: 888-405-6396
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9821
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: