Healthcare Provider Details

I. General information

NPI: 1780119412
Provider Name (Legal Business Name): JESSIE DAVIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE NAVARRA DO

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MARIO CAPECCHI DR RM 2S200
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 N MARIO CAPECCHI DR RM 2S200
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7822
  • Fax:
Mailing address:
  • Phone: 801-581-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number14279187-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A16770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: