Individual
MR. DALLAS R DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5473 KEARNY VILLA RD STE 300, SAN DIEGO, CA 92123-1142
(619) 605-9393
(619) 684-7004
Mailing address
5473 KEARNY VILLA RD STE 300, SAN DIEGO, CA 92123-1142
(619) 605-9393
(619) 684-7004
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
21055
CA
175T00000X
Peer Specialist
—
CA
225400000X
Rehabilitation Practitioner
Primary
—
CA
Other
Enumeration date
06/06/2025
Last updated
11/21/2025
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