Healthcare Provider Details

I. General information

NPI: 1629432125
Provider Name (Legal Business Name): MARGARIE DAVIS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ALAMEDA DE LAS PULGAS STE 240
SAN MATEO CA
94403-1222
US

IV. Provider business mailing address

1950 ALAMEDA DE LAS PULGAS STE 240
SAN MATEO CA
94403-1222
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2661
  • Fax: 650-522-9830
Mailing address:
  • Phone: 650-573-2661
  • Fax: 650-522-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number683448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: