Healthcare Provider Details

I. General information

NPI: 1316771835
Provider Name (Legal Business Name): ROSANNA MARIE DAVIS CADC-CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 N A ST
OXNARD CA
93030-4369
US

IV. Provider business mailing address

3640 S G ST
OXNARD CA
93033-6040
US

V. Phone/Fax

Practice location:
  • Phone: 805-330-7213
  • Fax:
Mailing address:
  • Phone: 805-330-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC052400518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: