Healthcare Provider Details

I. General information

NPI: 1386003994
Provider Name (Legal Business Name): TALIA DAVIDOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 CALIFORNIA ST UPPR
BERKELEY CA
94703-2614
US

IV. Provider business mailing address

2344 6TH ST
BERKELEY CA
94710-2412
US

V. Phone/Fax

Practice location:
  • Phone: 650-269-2285
  • Fax:
Mailing address:
  • Phone: 510-981-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number63350
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number63350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: