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General NPI Number Information
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NPI Number | 1891475455
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Entity Type | Individual
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Provider Name | MINA DAVIS NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 321 W RINCON ST UNIT 412
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City | CORONA
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State | CA
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Zip | 92878-5710
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Country | US
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Telephone | 951-532-9913
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Fax |
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Provider Business Mailing Address
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Address Line | 321 W RINCON ST UNIT 412
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City | CORONA
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State | CA
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Zip | 92878-5710
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Country | US
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Telephone | 951-532-9913
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95025097
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WM0102X
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Taxonomy Name | Maternal Newborn Registered Nurse
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License Number | 95191633
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License Number State | CA
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