Individual
CHARLES R DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4004 BEYER BLVD, SAN YSIDRO, CA 92173-2007
(303) 579-9268
Mailing address
1601 PRECISION PARK LN, SAN DIEGO, CA 92173-1345
(619) 662-4100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
21195
CO
2084P0800X
Psychiatry Physician
Primary
G41219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01211952
—
CO
01
—
110519276
MEDICARE RAILROAD
—
05
—
PENDING
—
CO
Enumeration date
03/20/2007
Last updated
09/19/2024
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