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General NPI Number Information
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NPI Number | 1457383390
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Entity Type | Individual
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Provider Name | VICTORIA REGINA DAVIS REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | BLDG 170 INNER LOOP
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City | FORT IRWIN
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State | CA
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Zip | 92310
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Country | US
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Telephone | 760-380-5183
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Fax |
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Provider Business Mailing Address
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Address Line | 15752 SCOTT DR
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City | FONTANA
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State | CA
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Zip | 92336-5046
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Country | US
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Telephone | 951-235-6329
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 481436
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License Number State | CA
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