Healthcare Provider Details

I. General information

NPI: 1326963117
Provider Name (Legal Business Name): JENNA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA MIER

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S LUCIA AVE UNIT 1
REDONDO BEACH CA
90277-3507
US

IV. Provider business mailing address

111 S LUCIA AVE UNIT 1
REDONDO BEACH CA
90277-3507
US

V. Phone/Fax

Practice location:
  • Phone: 805-312-0738
  • Fax:
Mailing address:
  • Phone: 805-312-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95017336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: