MEDICARE: MS. ANGELA MICHELLE DAVIS M.S.,CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SP-2129-0	HI
2	235Z00000X	Speech-Language Pathologist	18624	CA

General Provider Information

NPI Number	:	1306092515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA MICHELLE DAVIS M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 7406
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-8806
Country	:	US
Telephone Number	:	213-458-8815
Fax Number	:

Provider Business Practice Location Address
First Line	:	4639 35TH ST UNIT 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-3571
Country	:	US
Telephone Number	:	213-458-8815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	07/06/2022

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