Healthcare Provider Details

I. General information

NPI: 1407761489
Provider Name (Legal Business Name): JILLIAN DAVENPORT, MD, FAAP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 STATION WAY STE B
ARROYO GRANDE CA
93420-3383
US

IV. Provider business mailing address

230 STATION WAY STE B
ARROYO GRANDE CA
93420-3383
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-3262
  • Fax: 805-473-3707
Mailing address:
  • Phone: 805-473-3262
  • Fax: 805-473-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JILLIAN DAVENPORT
Title or Position: OWNER
Credential: MD
Phone: 805-473-3262