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General NPI Number Information
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NPI Number | 1386756930
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Entity Type | Organization
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Legal Business Name | PAMELA D. DAVIS, M.D., INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 133 N. PRAIRIE AVE.
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City | INGLEWOOD
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State | CA
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Zip | 90301-4878
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Country | US
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Telephone | 310-419-0900
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Fax | 310-622-8776
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Provider Business Mailing Address
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Address Line | 133 N. PRAIRIE AVE.
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City | INGLEWOOD
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State | CA
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Zip | 90301-4878
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Country | US
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Telephone | 310-419-0900
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Fax | 310-622-8776
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Authorized Official
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Title or Position | OWNER/CEO
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Name | PAMELA D. DAVIS
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Credential | MD
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Telephone | 949-413-3541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G46258
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G46258
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License Number State | CA
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