Healthcare Provider Details

I. General information

NPI: 1730159492
Provider Name (Legal Business Name): DAVID M DAVIS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20101 SW BIRCH ST STE 100
NEWPORT BEACH CA
92660-1249
US

IV. Provider business mailing address

20101 SW BIRCH ST STE 100
NEWPORT BEACH CA
92660-1249
US

V. Phone/Fax

Practice location:
  • Phone: 949-955-9080
  • Fax: 949-955-9061
Mailing address:
  • Phone: 949-955-9080
  • Fax: 949-955-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC037372
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID M DAVIS
Title or Position: PRESIDENT DAVID M DAVIS MD INC
Credential: MD
Phone: 949-955-4080