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NPI Code Detail

MEDICARE: MRS. LUISA DAVIS

MEDICARE: MRS. LUISA 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) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1R1316680718OTHERCACCAPP

General Provider Information

NPI Number : 1417532896
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LUISA DAVIS
Provider Business Mailing Address
First Line : 1203 E VERMONT AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92805-5622
Country : US
Telephone Number : 714-997-2674
Fax Number :
Provider Business Practice Location Address
First Line : 1203 E VERMONT AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92805-5622
Country : US
Telephone Number : 714-997-2674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2021
Last Update Date : 03/16/2021

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