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General NPI Number Information
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NPI Number | 1962044206
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Entity Type | Individual
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Provider Name | DAVINESHA MARIE SALLY
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Gender | Female
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 840 N AVENUE 66
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City | LOS ANGELES
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State | CA
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Zip | 90042-1508
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Country | US
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Telephone | 626-395-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 840 N AVENUE 66
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City | LOS ANGELES
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State | CA
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Zip | 90042-1508
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Country | US
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Telephone | 626-395-7100
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 95376792
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | 41383
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 41383
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95376792
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License Number State | CA
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