Individual
BRENT P DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4309 3RD AVE, SAN DIEGO, CA 92103-1407
(619) 876-4502
Mailing address
4309 3RD AVE, SAN DIEGO, CA 92103-1407
(619) 876-4502
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
584068
CA
Other
Enumeration date
07/16/2020
Last updated
07/16/2020
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