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Individual
QUEEN MARY DAVIS
Active
Individual
QUEEN MARY DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
CA #0367076
CA
172V00000X
Community Health Worker
CA# 0367076
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0055719
REGISTERED LOS ANGELES COUNTY VENDOR
—
01
—
20080702766
FICTITIOUS BUSINESS NAME STATEMENT
CA
01
—
CA# 0367076
DEPARTMENT OF MOTOR VEHICLES- MOTOR CARRIER
CA
01
—
NAICS 624120
SERVICE FOR ELDERLY AND PERSONS WITH DISABILITIES
CA
01
—
SIC 8322
INDIVIDUAL & FAMILY SOCIAL SERVICE
CA
Enumeration date
01/14/2009
Last updated
01/14/2009
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