Healthcare Provider Details

I. General information

NPI: 1104152628
Provider Name (Legal Business Name): TOM BELLE DAVIDSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

6430 W SUNSET BLVD
LOS ANGELES CA
90028-7900
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2109
  • Fax: 323-361-3891
Mailing address:
  • Phone: 323-361-2337
  • Fax: 323-361-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberA95340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: