Healthcare Provider Details

I. General information

NPI: 1063003986
Provider Name (Legal Business Name): LYDIA MICHELE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 SWEETWATER SPRINGS BLVD APT 11
SPRING VALLEY CA
91978-1061
US

IV. Provider business mailing address

3289 SWEETWATER SPRINGS BLVD APT 11
SPRING VALLEY CA
91978-1061
US

V. Phone/Fax

Practice location:
  • Phone: 619-735-5216
  • Fax:
Mailing address:
  • Phone: 619-735-5216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: