Individual
CARRIE DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
35200 BOB HOPE DR, RANCHO MIRAGE, CA 92270-1748
(760) 328-8884
Mailing address
35200 BOB HOPE DR, RANCHO MIRAGE, CA 92270-1748
(760) 328-8884
(760) 202-3931
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
CA55091
CA
363A00000X
Physician Assistant
Primary
CA55091
CA
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA55091
THE MEDICAL BOARD OF CALIFORNIA
CA
Enumeration date
11/16/2017
Last updated
07/29/2021
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