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General NPI Number Information
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NPI Number | 1083728513
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Entity Type | Individual
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Provider Name | JOHN AUSTIN DAVIS PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 12/25/2018
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Provider Practice Location Address
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Address Line | 300 E STATE ST
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City | REDLANDS
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State | CA
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Zip | 92373-5235
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Country | US
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Telephone | 909-214-3968
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Fax |
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Provider Business Mailing Address
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Address Line | 9341 LOFTY LN
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City | CHERRY VALLEY
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State | CA
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Zip | 92223-3659
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Country | US
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Telephone | 909-214-3968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY19368
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License Number State | CA
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