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NPI Code Detail

MEDICARE: DAVID W DAVIDSON

MEDICARE:   DAVID W DAVIDSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistLMFT91243CA

General Provider Information

NPI Number : 1184083115
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID W DAVIDSON
Provider Business Mailing Address
First Line : 5502 VINTAGE CIR
Second Line :
City : STOCKTON
State : CA
Zip : 95219-2510
Country : US
Telephone Number : 209-898-1615
Fax Number :
Provider Business Practice Location Address
First Line : 2431 W MARCH LN
Second Line : SUITE 210
City : STOCKTON
State : CA
Zip : 95207-8211
Country : US
Telephone Number : 209-898-9859
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2016
Last Update Date : 02/18/2016

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Directions to “ DAVID W DAVIDSON ” Practice Location

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