MEDICARE: CHRISTIANA DAVISSON MA, QASP-S, RBT

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
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1659151181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIANA DAVISSON MA, QASP-S, RBT

Provider Business Mailing Address
First Line	:	4856 W ADAMS BLVD # 1/2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2846
Country	:	US
Telephone Number	:	323-422-0853
Fax Number	:

Provider Business Practice Location Address
First Line	:	4856 W ADAMS BLVD # 1/2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2846
Country	:	US
Telephone Number	:	323-422-0853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	03/25/2024

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