Healthcare Provider Details

I. General information

NPI: 1689782013
Provider Name (Legal Business Name): MRS. DANIELLE L DAVIDSON-MCBEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE L DAVIDSON MD

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NORTH LABREA AVE
INGLEWOOD CA
90301-1708
US

IV. Provider business mailing address

110 NORTH LABREA AVE
INGLEWOOD CA
90301-1708
US

V. Phone/Fax

Practice location:
  • Phone: 310-419-3378
  • Fax: 310-419-3401
Mailing address:
  • Phone: 310-419-3378
  • Fax: 310-419-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA87599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: