Individual
DEBORAH DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1207 E FRUIT ST BLDG F, SANTA ANA, CA 92701-4206
(714) 953-9373
Mailing address
1207 E FRUIT ST BLDG F, SANTA ANA, CA 92701-4206
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225332802
MEDI-CAL
CA
Enumeration date
08/30/2011
Last updated
08/30/2011
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