Individual
MS. JUANITA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3444 E MELODY DR, PHOENIX, AZ 85042-7265
(602) 454-9440
Mailing address
3444 E MELODY DR, PHOENIX, AZ 85042-7265
(602) 454-9440
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
10729
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112538
AHCCCS ID NUMBER
AZ
Enumeration date
11/28/2006
Last updated
07/08/2007
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