Healthcare Provider Details

I. General information

NPI: 1205989308
Provider Name (Legal Business Name): RHONDA NAOMI DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E MAIN ST STE 102
SANTA MARIA CA
93454-4831
US

IV. Provider business mailing address

372 PUESTA DEL SOL
ARROYO GRANDE CA
93420-1436
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-7951
  • Fax: 805-928-6839
Mailing address:
  • Phone: 805-481-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: