Healthcare Provider Details

I. General information

NPI: 1285289975
Provider Name (Legal Business Name): CHRISTA FAITH DAVISON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 05/19/2022
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E AVENUE K6 STE B
LANCASTER CA
93535-4645
US

IV. Provider business mailing address

241 N FIGUEROA ST RM 306E
LOS ANGELES CA
90012-2601
US

V. Phone/Fax

Practice location:
  • Phone: 661-471-4000
  • Fax:
Mailing address:
  • Phone: 213-822-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: