Healthcare Provider Details

I. General information

NPI: 1124818083
Provider Name (Legal Business Name): DAVID BENJAMIN DAVIS III RN, MSN, MHS, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

IV. Provider business mailing address

2956 ROSSMORE CT
SAN JOSE CA
95148-3524
US

V. Phone/Fax

Practice location:
  • Phone: 831-345-3266
  • Fax:
Mailing address:
  • Phone: 650-743-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036726
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number552048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: