Healthcare Provider Details

I. General information

NPI: 1881032043
Provider Name (Legal Business Name): CAROLYN DAVIES M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date: 12/18/2020
Reactivation Date: 01/20/2021

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

11949 GOSHEN AVE #309
LOS ANGELES CA
90049-7321
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: