MEDICARE: DR. TERI DANIELLE 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
1	103TC0700X	Clinical Psychologist	29799	CA

General Provider Information

NPI Number	:	1831469444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERI DANIELLE DAVIS PHD

Provider Business Mailing Address
First Line	:	1744 FORUM WAY UNIT D
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92881-3290
Country	:	US
Telephone Number	:	424-646-3743
Fax Number	:

Provider Business Practice Location Address
First Line	:	3756 SANTA ROSALIA DR STE 420
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3614
Country	:	US
Telephone Number	:	424-646-3743
Fax Number	:

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

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	10/26/2022

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