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General NPI Number Information
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NPI Number | 1265422703
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Entity Type | Individual
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Provider Name | ROSALIE DAVIS PHD, RXP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3003 LOUISIANA BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-2734
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Country | US
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Telephone | 505-881-0404
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Fax | 505-881-4654
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Provider Business Mailing Address
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Address Line | 3003 LOUISIANA BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-2734
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Country | US
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Telephone | 505-881-0404
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Fax | 505-881-4654
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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 | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 0009
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 137
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License Number State | NM
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