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NPI Code Detail

MEDICARE: DR. ANGELA DAVIS PHD

MEDICARE: DR. ANGELA DAVIS PHD
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
1103TS0200XSchool PsychologistCA

General Provider Information

NPI Number : 1619834744
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA DAVIS PHD
Provider Business Mailing Address
First Line : 115 W ALLEN AVE
Second Line :
City : SAN DIMAS
State : CA
Zip : 91773-1437
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 115 W ALLEN AVE
Second Line :
City : SAN DIMAS
State : CA
Zip : 91773-1437
Country : US
Telephone Number : 909-971-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2026
Last Update Date : 01/09/2026

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Directions to “ DR. ANGELA DAVIS PHD” Practice Location

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