1548626807 NPI number — DAVIS PSYCHOLOGICAL EDUCATIONAL SERVICES, INC.

Table of content: (NPI 1548626807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548626807 NPI number — DAVIS PSYCHOLOGICAL EDUCATIONAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVIS PSYCHOLOGICAL EDUCATIONAL SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1548626807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2619
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90247-0619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-422-7138
Provider Business Mailing Address Fax Number:
323-777-6674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10900 183RD ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CERRITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90703-5342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-854-6284
Provider Business Practice Location Address Fax Number:
562-219-5013
Provider Enumeration Date:
01/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
ALPHONSO
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGICAL ASSISTANT
Authorized Official Telephone Number:
323-422-7138

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSB94021086 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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