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NPI Code Detail

MEDICARE: LORA MARIE ANTOINETTE DAVIS RSUDC

MEDICARE: LORA MARIE ANTOINETTE DAVIS RSUDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor23397CA

General Provider Information

NPI Number : 1356292882
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORA MARIE ANTOINETTE DAVIS RSUDC
Provider Business Mailing Address
First Line : 333 N SAN JOAQUIN ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-2954
Country : US
Telephone Number : 209-683-9300
Fax Number :
Provider Business Practice Location Address
First Line : 417 N AMERICAN ST APT G
Second Line :
City : STOCKTON
State : CA
Zip : 95202-2104
Country : US
Telephone Number : 209-683-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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