Healthcare Provider Details

I. General information

NPI: 1497976039
Provider Name (Legal Business Name): RONALD JAY DAVIDSON MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 WILSHIRE BLVD STE 800
BEVERLY HILLS CA
90211-2440
US

IV. Provider business mailing address

8383 WILSHIRE BLVD STE 800
BEVERLY HILLS CA
90211-2440
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-7176
  • Fax: 310-271-3460
Mailing address:
  • Phone: 310-271-7176
  • Fax: 310-271-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD JAY DAVIDSON
Title or Position: OWNER
Credential: M.D.
Phone: 310-271-7176