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General NPI Number Information
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NPI Number | 1124054119
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Entity Type | Individual
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Provider Name | RANDALL B DAVIS LMFT
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 1101 CALIFORNIA AVE STE 100
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City | CORONA
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State | CA
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Zip | 92881-6472
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Country | US
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Telephone | 951-736-8193
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Fax | 888-388-0170
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Provider Business Mailing Address
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Address Line | 3943 IRVINE BLVD # 406
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City | IRVINE
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State | CA
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Zip | 92602-2400
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Country | US
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Telephone | 951-736-8193
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Fax | 888-388-0170
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 19383
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License Number State | CA
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