Individual
DAVINESHA MARIE SALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Mailing address
840 N AVENUE 66, LOS ANGELES, CA 90042-1508
(626) 395-7100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95376792
CA
163WP0808X
Psychiatric/Mental Health Registered Nurse
95376792
CA
167G00000X
Licensed Psychiatric Technician
41383
CA
225400000X
Rehabilitation Practitioner
41383
CA
Other
Enumeration date
10/08/2019
Last updated
05/28/2024
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