Individual
DANIEL DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3851 KATELLA AVE STE 202, LOS ALAMITOS, CA 90720-3497
(562) 206-0177
Mailing address
PHR GROUP PROVIDER ENROLLMENT UNIT, 393 E WALNUT ST FL 3, PASADENA, CA 91188-0001
(877) 608-0044
(877) 514-0903
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
53557
CA
Other
Enumeration date
06/01/2016
Last updated
10/12/2021
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