Healthcare Provider Details

I. General information

NPI: 1871724567
Provider Name (Legal Business Name): CAROL LYNN DAVIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N ROSE AVE
OXNARD CA
93030-3722
US

IV. Provider business mailing address

PO BOX 660879
ARCADIA CA
91066-0879
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-2843
  • Fax: 805-988-2844
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP14644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: