Healthcare Provider Details

I. General information

NPI: 1225955305
Provider Name (Legal Business Name): QUENETTA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6596 INDIANA AVE APT 7
BUENA PARK CA
90621-3532
US

IV. Provider business mailing address

6596 INDIANA AVE APT 7
BUENA PARK CA
90621-3532
US

V. Phone/Fax

Practice location:
  • Phone: 323-574-0947
  • Fax:
Mailing address:
  • Phone: 323-574-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: