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General NPI Number Information
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NPI Number | 1831814508
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Entity Type | Individual
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Provider Name | CALVIN TRAVON DAVIS PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 4580 PACIFIC BLVD. (STACY MEDICAL CENTER)
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City | VERNON
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State | CA
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Zip | 90058
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Country | US
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Telephone | 323-584-0779
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Fax | 323-582-2282
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Provider Business Mailing Address
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Address Line | 15632 HASKINS AVE.
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City | COMPTON
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State | CA
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Zip | 90220
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Country | US
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Telephone | 323-203-4678
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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 | 15426
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License Number State | CA
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