Healthcare Provider Details

I. General information

NPI: 1083523898
Provider Name (Legal Business Name): ASHLEY DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13590 COPPERSTONE DR
VICTORVILLE CA
92392-8737
US

IV. Provider business mailing address

13590 COPPERSTONE DR
VICTORVILLE CA
92392-8737
US

V. Phone/Fax

Practice location:
  • Phone: 323-799-6805
  • Fax:
Mailing address:
  • Phone: 323-799-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: