=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679611099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORMAN A DAVIS PSYD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 WEST MAIN ST #201
-----------------------------------------------------
City | TURLOCK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-664-1300
-----------------------------------------------------
Fax | 209-664-1311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3008 MARAZAN ST
-----------------------------------------------------
City | DENAIR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-664-1300
-----------------------------------------------------
Fax | 209-664-1311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY17314
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 695
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------