Individual
PHILIP M. DA VISIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
525 W ACACIA ST, STOCKTON, CA 95203-2405
(209) 944-5550
Mailing address
PO BOX 11101, WESTMINSTER, CA 92685-1101
(866) 878-5075
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
PA17470
CA
363A00000X
Physician Assistant
PA17470
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA17470
—
CA
Enumeration date
08/07/2006
Last updated
01/03/2022
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