Healthcare Provider Details

I. General information

NPI: 1548123052
Provider Name (Legal Business Name): NEOMI DAVIS-WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROFESSIONAL CENTER PKWY
SAN RAFAEL CA
94903-2703
US

IV. Provider business mailing address

2342 SHATTUCK AVE # 200
BERKELEY CA
94704-1517
US

V. Phone/Fax

Practice location:
  • Phone: 415-482-6182
  • Fax:
Mailing address:
  • Phone: 510-495-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: