Healthcare Provider Details

I. General information

NPI: 1851685101
Provider Name (Legal Business Name): MISHEDA DAVORA MYLESDAVIS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 CHICAGO AVE # 2093
RIVERSIDE CA
92507-5340
US

IV. Provider business mailing address

4020 CHICAGO AVE # 2093
RIVERSIDE CA
92507-5340
US

V. Phone/Fax

Practice location:
  • Phone: 951-546-2578
  • Fax:
Mailing address:
  • Phone: 951-546-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95038183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: