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General NPI Number Information
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NPI Number | 1467589457
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Entity Type | Individual
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Provider Name | SALLY JOYCE DAVIS PA
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7601 EAST IMPERIAL BLVD. RANCHO LOS AMIGOS JPI 3RD FLOOR NEUROREHAB OFFICE
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City | DOWNEY
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State | CA
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Zip | 90242
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Country | US
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Telephone | 562-401-7713
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Fax |
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Provider Business Mailing Address
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Address Line | 21213 HAWTHORNE BLVD #B5496
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City | TORRANCE
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State | CA
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Zip | 90503-5501
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Country | US
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Telephone | 310-597-6040
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 14342
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License Number State | CA
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