Healthcare Provider Details

I. General information

NPI: 1629020409
Provider Name (Legal Business Name): MELISSA SUSAN DAVIS LLABRES PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MELISSA SUSAN DAVIS KALB

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 ZANKER ROAD
SAN JOSE CA
95134-2299
US

IV. Provider business mailing address

1600 9TH ST ROOM 205 MAILSTOP 2-3
SACRAMENTO CA
95814-6414
US

V. Phone/Fax

Practice location:
  • Phone: 408-451-6198
  • Fax:
Mailing address:
  • Phone: 916-654-2431
  • Fax: 916-654-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY19791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: