1932328903 NPI number — DR. L. JEANNETTE DAVIS D.S.W.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932328903 NPI number — DR. L. JEANNETTE DAVIS D.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
L. JEANNETTE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
L. JEANNETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.S.W.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932328903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 CALIFORNIA BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-2949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-546-2104
Provider Business Mailing Address Fax Number:
805-528-6994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 CALIFORNIA BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-546-2104
Provider Business Practice Location Address Fax Number:
805-528-6994
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW 2585 , 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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