Healthcare Provider Details

I. General information

NPI: 1629605837
Provider Name (Legal Business Name): DAVI ANDRADE MAVROMATIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 WHITE LN
BAKERSFIELD CA
93309-6200
US

IV. Provider business mailing address

1450 W LONG LAKE RD STE 340
TROY MI
48098-6330
US

V. Phone/Fax

Practice location:
  • Phone: 661-398-1800
  • Fax: 661-241-5587
Mailing address:
  • Phone: 248-905-5091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRTL22-0165
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA205920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: