Healthcare Provider Details

I. General information

NPI: 1780539288
Provider Name (Legal Business Name): NYAA DANIELLE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19503 GALWAY AVE
CARSON CA
90746-1923
US

IV. Provider business mailing address

636 PACIFIC AVE APT 438
LONG BEACH CA
90802-1393
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-9021
  • Fax:
Mailing address:
  • Phone: 562-595-9021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: