Healthcare Provider Details

I. General information

NPI: 1104062033
Provider Name (Legal Business Name): LUTHER EUGENE DAVIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST # 116A
LOMA LINDA CA
92357-3477
US

IV. Provider business mailing address

149 HART ST SUITE 5
SHEPPARD AFB TX
76311-3477
US

V. Phone/Fax

Practice location:
  • Phone: 909-894-7424
  • Fax:
Mailing address:
  • Phone: 940-676-6075
  • Fax: 940-676-6076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: