=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972534691
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINE H DAVIDSON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 02/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50100 GOLSH RD
-----------------------------------------------------
City | VALLEY CENTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92082-5338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-749-1410
-----------------------------------------------------
Fax | 760-749-2577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50100 GOLSH RD
-----------------------------------------------------
City | VALLEY CENTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92082-5338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-749-1410
-----------------------------------------------------
Fax | 760-749-2577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A55617
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------