Organization
DR. DANTAE D DAVIES MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANTAE D. DAVIES M.D. (PRESIDENT)
(805) 577-7977
Entity
Organization
Contact information
Practice address
1189 SWALLOW LN STE 201, SIMI VALLEY, CA 93065-3157
(805) 577-7977
(805) 577-0745
Mailing address
1189 SWALLOW LANE, SUITE 201, SIMI VALLEY, CA 93065-3157
(805) 577-7977
(805) 577-0745
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G28898
CA
208600000X
Surgery Physician
G28898
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G288980
—
CA
Enumeration date
04/22/2007
Last updated
11/09/2017
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