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NPI Code Detail

MEDICARE: MS. TONI LYNELL DAVIS

MEDICARE: MS. TONI LYNELL DAVIS
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) Counselor1913370CA

General Provider Information

NPI Number : 1366112088
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TONI LYNELL DAVIS
Provider Business Mailing Address
First Line : 15519 CRENSHAW BLVD
Second Line :
City : GARDENA
State : CA
Zip : 90249-4597
Country : US
Telephone Number : 310-679-9031
Fax Number :
Provider Business Practice Location Address
First Line : 15519 CRENSHAW BLVD
Second Line :
City : GARDENA
State : CA
Zip : 90249-4597
Country : US
Telephone Number : 310-679-9031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2021
Last Update Date : 09/14/2021

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