Healthcare Provider Details

I. General information

NPI: 1013304286
Provider Name (Legal Business Name): RACHEL ELIZABETH GELFOND DAVIDGE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON STREET LOMA LINDA UNIVERSITY HEALTH, GENERAL PEDIATRICS
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11175 CAMPUS STREET COLEMAN PAVILION, SUITE A1121
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4174
  • Fax:
Mailing address:
  • Phone: 909-558-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A15105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: