Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | G55828 | CA |
NPI | 1114069705 |
---|---|
Provider Name | Dr. Charles B. Davis |
First Address | San Diego, CA 92130-2726 |
Second Address | San Diego, CA 92134-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |