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Individual

MISS LARIS OLIVIA DAVENPORT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
200 W ARBOR DR, SAN DIEGO, CA 92103-9000
(800) 926-8273
(888) 539-8781
Mailing address
FILE 57326, LOS ANGELES, CA 90074-7326
(858) 249-6748

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
710866
PA
367500000X
Certified Registered Nurse Anesthetist
147782
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
NA95002421
CA

Other

Enumeration date
01/26/2021
Last updated
08/27/2024
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