Healthcare Provider Details

I. General information

NPI: 1235828039
Provider Name (Legal Business Name): ALIA DAVIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 S I ST STE 102
TACOMA WA
98405-5029
US

IV. Provider business mailing address

3102 CHRISTOPHERS WATCH LN
RUSKIN FL
33570-3051
US

V. Phone/Fax

Practice location:
  • Phone: 253-428-8700
  • Fax:
Mailing address:
  • Phone: 727-687-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61433283
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA.PA.61433283
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: