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General NPI Number Information
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NPI Number | 1104062033
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Entity Type | Individual
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Provider Name | LUTHER EUGENE DAVIS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/24/2008
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 11201 BENTON ST # 116A
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City | LOMA LINDA
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State | CA
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Zip | 92357-3477
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Country | US
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Telephone | 909-894-7424
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Fax |
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Provider Business Mailing Address
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Address Line | 149 HART ST SUITE 5
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City | SHEPPARD AFB
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State | TX
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Zip | 76311-3477
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Country | US
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Telephone | 940-676-6075
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Fax | 940-676-6076
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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 | PSY22384
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License Number State | CA
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