Individual
LISA CAROL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-3144
(909) 580-2165
Mailing address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-3144
(909) 580-2165
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
650954
CA
Other
Enumeration date
06/29/2010
Last updated
06/29/2010
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