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NPI Code Detail

MEDICARE: MRS. SUSANN PAULETTE DAVIS RN

MEDICARE: MRS. SUSANN PAULETTE DAVIS RN
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
1101YM0800XMental Health CounselorCA

General Provider Information

NPI Number : 1467632190
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSANN PAULETTE DAVIS RN
Provider Business Mailing Address
First Line : 13039 LAKEVIEW GRANADA DR
Second Line :
City : LAKESIDE
State : CA
Zip : 92040-4719
Country : US
Telephone Number : 619-561-0270
Fax Number :
Provider Business Practice Location Address
First Line : 1094 CUDAHY PL STE 314
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-3924
Country : US
Telephone Number : 619-561-0270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2007
Last Update Date : 11/09/2007

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