1538368808 NPI number — MISS DORSHONDA LATOYA DAVIS MA, MFT, AMFT, PSYDC

Table of content: MISS DORSHONDA LATOYA DAVIS MA, MFT, AMFT, PSYDC (NPI 1538368808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538368808 NPI number — MISS DORSHONDA LATOYA DAVIS MA, MFT, AMFT, PSYDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
DORSHONDA
Provider Middle Name:
LATOYA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA, MFT, AMFT, PSYDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538368808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3002
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:
90247-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-296-6831
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3360 E IMPERIAL HWY # 220-240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90262-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-769-7174
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2007

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: 106H00000X , with the licence number:  131924 , 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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