Healthcare Provider Details

I. General information

NPI: 1164070041
Provider Name (Legal Business Name): DAVID ALAN DAVIS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17460 KRAMERIA AVE
RIVERSIDE CA
92504-6129
US

IV. Provider business mailing address

1940 S HELEN AVE
ONTARIO CA
91762-6025
US

V. Phone/Fax

Practice location:
  • Phone: 951-707-5665
  • Fax:
Mailing address:
  • Phone: 805-215-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: