Healthcare Provider Details

I. General information

NPI: 1396759346
Provider Name (Legal Business Name): KAREN J DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 1/2 POTRERO RD
BANNING CA
92220-6946
US

IV. Provider business mailing address

11555 1/2 POTRERO RD
BANNING CA
92220-6946
US

V. Phone/Fax

Practice location:
  • Phone: 951-849-4761
  • Fax: 951-487-9634
Mailing address:
  • Phone: 951-849-4761
  • Fax: 951-487-9634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA45723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: