Healthcare Provider Details

I. General information

NPI: 1740428358
Provider Name (Legal Business Name): JUDITH M DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CREEKSIDE DR #36
WALNUT CREEK CA
94596-5558
US

IV. Provider business mailing address

1450 CREEKSIDE DR #36
WALNUT CREEK CA
94596-5558
US

V. Phone/Fax

Practice location:
  • Phone: 925-705-5191
  • Fax:
Mailing address:
  • Phone: 925-705-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG13583
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36-48264
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: