Healthcare Provider Details

I. General information

NPI: 1922692656
Provider Name (Legal Business Name): RENEE CHRISTINE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 NAGLEE RD
TRACY CA
95304-7307
US

IV. Provider business mailing address

538 E MAIN ST
RIPON CA
95366-2904
US

V. Phone/Fax

Practice location:
  • Phone: 209-833-0072
  • Fax: 209-221-4622
Mailing address:
  • Phone: 209-627-5921
  • Fax: 209-221-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number55898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: