Healthcare Provider Details

I. General information

NPI: 1164944856
Provider Name (Legal Business Name): DEANNA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1444
RANCHO CORDOVA CA
95741-1444
US

IV. Provider business mailing address

PO BOX 1444
RANCHO CORDOVA CA
95741-1444
US

V. Phone/Fax

Practice location:
  • Phone: 916-208-8243
  • Fax: 916-250-0137
Mailing address:
  • Phone: 916-208-8243
  • Fax: 916-250-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102566
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: