Healthcare Provider Details

I. General information

NPI: 1427995414
Provider Name (Legal Business Name): LEONYIA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE BLDG 18
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

12021 WILMINGTON AVE BLDG 18
LOS ANGELES CA
90059-3019
US

V. Phone/Fax

Practice location:
  • Phone: 424-454-5490
  • Fax: 310-461-1132
Mailing address:
  • Phone: 424-454-5490
  • Fax: 310-461-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number749454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: